Delayed diagnosis of slipped upper femoral epiphysis (SUFE) can result in
lifelong disability and medicolegal claims of more than ВЈ100,000, according
to a report in the latest (Spring 2008) edition of Summons, the magazine of
MDDUS, The Medical and Dental Defence Union of Scotland.
The condition occurs in up to seven individuals per 100,000 and, as such, is
likely to be encountered once or twice in any one GP's career, says Jamie
MacLean, who as lead consultant at Tayside Children's Orthopaedic Service
provides expert reports for MDDUS.
A 2.5 fold increase in the incidence of SUFE has been recently reported,
with a suggested link to the growing problem of childhood obesity, says Mr
MacLean.
SUFE persists as a regular source of medicolegal claims, often in excess of
ВЈ100,000, adds Dr Rob Hendry, a medicolegal adviser at MDDUS. Claims are
unusual but regularly encountered. "Every year we usually see one or two
cases. Where the outcome can be so devastating, it's one or two too many.
"In the practice of medicine there are relatively few conditions in which an
early diagnosis can make a radical difference to the outcome for a patient.
SUFE is one of them. Miss it, and both patient and doctor can live to regret
it. GPs should have a high index of suspicion when it comes to SUFE-like
symptoms."
SUFE occurs typically among children aged between 10 and 16, in twice as
many boys as girls. However, there has been an increase in children as young
as eight presenting with SUFE, and when it occurs at this age, bilateral
disease is more common. SUFE tends to affect obese children, but may also
occur in tall thin individuals.
Conditions associated with increased risk of SUFE in children include a
previous slip on the other side, hypothyroidism, hypogonadism,
panhypopituitarism, primary and secondary hyperparathyroidism and growth
hormone deficiency. Children on steroids, or undergoing chemotherapy or
radiotherapy, may also be at increased risk of SUFE.
SUFE can be 'silent' and painless with deformity developing slowly over
months. Usually the onset of symptoms is insidious. When they follow sport
they can easily be incorrectly attributed to muscle strain.
Most patients have hip or groin pain, but a fifth of patients report
isolated knee or thigh pain, and these are particularly at risk of
misdiagnosis.
"SUFE is a condition that progresses and so it's important to recognise any
increase in the severity of symptoms or signs," says Mr MacLean.
Pain on weight bearing is an important symptom. In five to 10 per cent of
cases the condition can become rapidly progressive, as reflected by an
inability to weightbear. Such cases represent a genuine surgical emergency.
The outcome in this subgroup is invariably very poor unless referred for
treatment immediately.
"Unfortunately, delay in diagnosis occurs both in general practice and
hospital and can have a devastating effect on the outcome - a disabled
adolescent being the end result," says Mr MacLean. Early diagnosis enables
uncomplicated surgical intervention with the expectation of a near to normal
outcome. If misdiagnosed, "individual cases make sad reading, with major
impacts on patients' lives and, indeed, attitudes to life and work," says Mr
MacLean.
Common pitfalls leading to claims include failure to consider the diagnosis,
failure to examine the hip, being falsely reassured by a previous "normal"
X-ray and failing to appreciate the urgency of referral. In this age group
hip, groin, distal thigh or knee pain should always be regarded as a
potential SUFE. Indeed, any child complaining of knee pain in whom the knee
examination is normal should be regarded as a case of SUFE until proven
otherwise.
The loss of earnings potential in patients who cannot pursue their intended
careers subsequent to SUFE accounts for those cases which settle for over
ВЈ100,000, whilst those involving pain and cosmetic problems - invariably
with an increased risk of osteoarthritis - settle at around ВЈ10,000-ВЈ60,000.
MDDUS is a medical defence organisation providing access to
professional indemnity and expert medicolegal advice for doctors, dentists
and other healthcare professionals throughout the UK.
mddus
воскресенье, 23 октября 2011 г.
четверг, 20 октября 2011 г.
Depuy Orthopaedics Launches Significant Enhancements To Its Sigma(R) Knee Product Portfolio
DePuy Orthopaedics, Inc., a global leader in
devices for joint replacement, announced the launch of new products in its portfolio of
Sigma® Knee products that offer surgeons the ability to select from a wide range of instruments
and implants based on a spectrum of patient needs and their own surgical preferences.
"The launch of these new Sigma Knee products signals a new wave of innovation that will have
significant effects on patient care," said David Floyd, President, DePuy Orthopaedics, Inc.
"These significant enhancements to the Sigma Knee group are the beginning of a new era of
products and solutions designed to offer high performance instrumentation, customization,
quicker recovery, and longer-term durability for the wide range of patients seeking knee
replacement today."
DePuy Orthopaedics made the announcement at the 75th Annual Meeting of the American Academy
of Orthopaedic Surgeons (AAOS), where it will showcase these new products, including Sigma
High Performance instruments, a new line of instruments designed to enhance procedure efficiency,
surgical precision and flexibility. Designed for contemporary knee surgery, the High Performance
Instruments adapt to a surgeon's specific surgical technique, including computer assisted surgery
and manual surgery, with both minimally invasive and traditional open approaches. Sigma High
Performance instruments were developed with a compact design to allow for smaller incisions and
are soft-tissue friendly to reduce surgical trauma. This is DePuy Orthopaedics' largest introduction
of instrumentation in a decade.
"Sigma High Performance Instruments are the most advanced instrumentation we have ever
developed, and the initial feedback from surgeons who've already used the instruments is
extremely positive. These instruments will further contribute to the excellent results seen with
our Sigma Knee implants," said Tom Lavery, Vice-President Marketing, Knees.
Also at AAOS DePuy Orthopaedics is introducing into the Sigma Knee product group the Sigma
CR Porocoat Femur, a cement-less fixation femoral component that contains a porous coating
conducive to deep bone ingrowth and better long-term fixation of the implant and the Sigma PS
Femur, designed to provide today's high demand patients with enhanced function from gait to
deep flexion activities, and the next generation in computer assisted knee software, Ci™ Essential
Knee.
DePuy will introduce additional Sigma Knee products and services over the next 18 months.
The Sigma Knee will also be part of a consumer education campaign called Sigma -- My knee.
My life™. This campaign will encourage patients to talk with their surgeons about which Sigma
knee replacement system will best fit their lifestyle and activity level. For more information visit
kneereplacement.
About Knee Replacement
According to the AAOS more than 500,000 total knee replacements are performed in the U.S.1
The AAOS notes that more joint replacement surgeries are performed on the knee than on any
other joint. In a total knee replacement, the knee is replaced by prostheses made of metal alloys,
high-grade plastics and polymeric materials. Most of the other structures of the knee remain
intact. Knee replacement surgery is generally recommended for patients with severe knee pain
and disability caused by damage to cartilage from rheumatoid arthritis, osteoarthritis or trauma.
It is highly successful in relieving pain and restoring joint function.
The performance of knee replacements depends on age, weight, activity level, and other factors.
There are potential risks and recovery takes time. People with conditions limiting rehabilitation
should not have this surgery. Only an orthopaedic surgeon can tell if knee replacement is right
for a patient.
About DePuy Orthopaedics, Inc.
DePuy Orthopaedics, Inc., a Johnson & Johnson company, is advancing the standard of
orthopaedic patient care, with a focused commitment to help surgeons achieve excellence in
surgical practice. The company designs, manufactures and distributes orthopaedic devices and
supplies including hip, knee, extremity, trauma, cement, orthobiologics, and operating room
products. As a global leader in joint replacement products, DePuy Orthopaedics is committed to
Restoring the Joy of Motion® for patients whose mobility is restricted by severe osteoarthritis or
other debilitating injury. For more information about DePuy Orthopaedics, Inc., visit the
company's Web site depuyorthopaedics.
This press release contains "forward-looking statements" as defined in the Private Securities
Litigation Reform Act of 1995. These statements are based on current expectations of future
events. If underlying assumptions prove inaccurate or unknown risks or uncertainties materialize,
actual results could vary materially from Johnson & Johnson's expectations and projections.
Risks and uncertainties include general industry conditions and competition; economic
conditions, such as interest rate and currency exchange rate fluctuations; technological advances
and patents attained by competitors; challenges inherent in new product development, including
obtaining regulatory approvals; domestic and foreign health care reforms and governmental laws
and regulations; and trends toward health care cost containment. A further list and description of
these risks, uncertainties and other factors can be found in Exhibit 99 of the Company's Annual
Report on Form 10-K for the fiscal year ended December 30, 2007. Copies of this Form 10-K, as
well as subsequent filings, are available online at sec, jnj or on request from
Johnson & Johnson. Johnson & Johnson does not undertake to update any forward-looking
statements as a result of new information or future events or developments.
Reference:
"Facts on Knee Replacements," American Academy of Orthopaedic Surgeons, 2005.
DePuy Orthopaedics
devices for joint replacement, announced the launch of new products in its portfolio of
Sigma® Knee products that offer surgeons the ability to select from a wide range of instruments
and implants based on a spectrum of patient needs and their own surgical preferences.
"The launch of these new Sigma Knee products signals a new wave of innovation that will have
significant effects on patient care," said David Floyd, President, DePuy Orthopaedics, Inc.
"These significant enhancements to the Sigma Knee group are the beginning of a new era of
products and solutions designed to offer high performance instrumentation, customization,
quicker recovery, and longer-term durability for the wide range of patients seeking knee
replacement today."
DePuy Orthopaedics made the announcement at the 75th Annual Meeting of the American Academy
of Orthopaedic Surgeons (AAOS), where it will showcase these new products, including Sigma
High Performance instruments, a new line of instruments designed to enhance procedure efficiency,
surgical precision and flexibility. Designed for contemporary knee surgery, the High Performance
Instruments adapt to a surgeon's specific surgical technique, including computer assisted surgery
and manual surgery, with both minimally invasive and traditional open approaches. Sigma High
Performance instruments were developed with a compact design to allow for smaller incisions and
are soft-tissue friendly to reduce surgical trauma. This is DePuy Orthopaedics' largest introduction
of instrumentation in a decade.
"Sigma High Performance Instruments are the most advanced instrumentation we have ever
developed, and the initial feedback from surgeons who've already used the instruments is
extremely positive. These instruments will further contribute to the excellent results seen with
our Sigma Knee implants," said Tom Lavery, Vice-President Marketing, Knees.
Also at AAOS DePuy Orthopaedics is introducing into the Sigma Knee product group the Sigma
CR Porocoat Femur, a cement-less fixation femoral component that contains a porous coating
conducive to deep bone ingrowth and better long-term fixation of the implant and the Sigma PS
Femur, designed to provide today's high demand patients with enhanced function from gait to
deep flexion activities, and the next generation in computer assisted knee software, Ci™ Essential
Knee.
DePuy will introduce additional Sigma Knee products and services over the next 18 months.
The Sigma Knee will also be part of a consumer education campaign called Sigma -- My knee.
My life™. This campaign will encourage patients to talk with their surgeons about which Sigma
knee replacement system will best fit their lifestyle and activity level. For more information visit
kneereplacement.
About Knee Replacement
According to the AAOS more than 500,000 total knee replacements are performed in the U.S.1
The AAOS notes that more joint replacement surgeries are performed on the knee than on any
other joint. In a total knee replacement, the knee is replaced by prostheses made of metal alloys,
high-grade plastics and polymeric materials. Most of the other structures of the knee remain
intact. Knee replacement surgery is generally recommended for patients with severe knee pain
and disability caused by damage to cartilage from rheumatoid arthritis, osteoarthritis or trauma.
It is highly successful in relieving pain and restoring joint function.
The performance of knee replacements depends on age, weight, activity level, and other factors.
There are potential risks and recovery takes time. People with conditions limiting rehabilitation
should not have this surgery. Only an orthopaedic surgeon can tell if knee replacement is right
for a patient.
About DePuy Orthopaedics, Inc.
DePuy Orthopaedics, Inc., a Johnson & Johnson company, is advancing the standard of
orthopaedic patient care, with a focused commitment to help surgeons achieve excellence in
surgical practice. The company designs, manufactures and distributes orthopaedic devices and
supplies including hip, knee, extremity, trauma, cement, orthobiologics, and operating room
products. As a global leader in joint replacement products, DePuy Orthopaedics is committed to
Restoring the Joy of Motion® for patients whose mobility is restricted by severe osteoarthritis or
other debilitating injury. For more information about DePuy Orthopaedics, Inc., visit the
company's Web site depuyorthopaedics.
This press release contains "forward-looking statements" as defined in the Private Securities
Litigation Reform Act of 1995. These statements are based on current expectations of future
events. If underlying assumptions prove inaccurate or unknown risks or uncertainties materialize,
actual results could vary materially from Johnson & Johnson's expectations and projections.
Risks and uncertainties include general industry conditions and competition; economic
conditions, such as interest rate and currency exchange rate fluctuations; technological advances
and patents attained by competitors; challenges inherent in new product development, including
obtaining regulatory approvals; domestic and foreign health care reforms and governmental laws
and regulations; and trends toward health care cost containment. A further list and description of
these risks, uncertainties and other factors can be found in Exhibit 99 of the Company's Annual
Report on Form 10-K for the fiscal year ended December 30, 2007. Copies of this Form 10-K, as
well as subsequent filings, are available online at sec, jnj or on request from
Johnson & Johnson. Johnson & Johnson does not undertake to update any forward-looking
statements as a result of new information or future events or developments.
Reference:
"Facts on Knee Replacements," American Academy of Orthopaedic Surgeons, 2005.
DePuy Orthopaedics
понедельник, 17 октября 2011 г.
Wyeth Receives Approvable Letter From FDA For Bazedoxifene For The Treatment Of Postmenopausal Osteoporosis
Wyeth Pharmaceuticals, a
division of Wyeth (NYSE: WYE), announced that the U.S. Food and Drug
Administration (FDA) issued an approvable letter on May 21 for
bazedoxifene, a selective estrogen receptor modulator, for the treatment of
postmenopausal osteoporosis. In the letter, the FDA requested information
similar to that outlined in its approvable letter for bazedoxifene's New
Drug Application (NDA) for the prevention of postmenopausal osteoporosis
issued in December 2007. This included further analyses concerning the
incidence of stroke and venous thrombotic events. The Agency also
identified specific questions concerning data collection and reporting and
requested additional source documents.
"Today's action is in line with our expectations," says Gary L. Stiles,
M.D., Executive Vice President, Chief Medical Officer, Wyeth
Pharmaceuticals. "In our conference with the Agency earlier this year, they
stated their desire to convene an advisory committee to review the pending
new drug applications for both treatment and prevention of postmenopausal
osteoporosis. We have been working closely with the FDA to address their
questions and we are preparing a complete response which we expect to file
by end of 2008. We remain committed to pursuing bazedoxifene as an
important new option for the millions of postmenopausal women at risk for
osteoporotic fracture."
About Osteoporosis
Osteoporosis is a disease characterized by low bone mass and structural
deterioration of bone tissue, leading to bone fragility and an increased
risk of fractures. According to the National Osteoporosis Foundation, the
number of women of menopausal age who have osteoporosis or are at risk for
developing the disease will increase from almost 30 million in 2002 to
nearly 41 million in 2020. Up to 20 percent of a woman's expected lifetime
bone loss can occur in the years immediately following menopause. The
treatment of postmenopausal osteoporosis could lead to significant
improvement in the overall health for millions of women worldwide as well
as reduce costs associated with postmenopausal osteoporosis-related
fractures.
About Wyeth Pharmaceuticals
Wyeth Pharmaceuticals, a division of Wyeth, has leading products in the
areas of women's health care, infectious disease, gastrointestinal health,
central nervous system, inflammation, transplantation, hemophilia,
oncology, vaccines and nutritional products.
Wyeth is one of the world's largest research-driven pharmaceutical and
health care products companies. It is a leader in the discovery,
development, manufacturing and marketing of pharmaceuticals, vaccines,
biotechnology products, nutritionals and non-prescription medicines that
improve the quality of life for people worldwide. The Company's major
divisions include Wyeth Pharmaceuticals, Wyeth Consumer Healthcare and Fort
Dodge Animal Health.
The statements in this press release that are not historical facts are
forward-looking statements that are subject to risks and uncertainties that
could cause actual results to differ materially from those expressed or
implied by such statements. These risks and uncertainties include, without
limitation, the inherent uncertainty of the timing and success of, and
expense associated with, research, development, regulatory approval and
commercialization of our products and pipeline products (including that
there can be no assurance that our pending new drug applications for
bazedoxifene will be approved or that the product will ever be successfully
commercialized); government cost-containment initiatives; restrictions on
third-party payments for our products; substantial competition in our
industry, including from branded and generic products; emerging data on our
products and pipeline products; the importance of strong performance from
our principal products and our anticipated new product introductions; the
highly regulated nature of our business; product liability, intellectual
property and other litigation risks and environmental liabilities;
uncertainty regarding our intellectual property rights and those of others;
difficulties associated with, and regulatory compliance with respect to,
manufacturing of our products; risks associated with our strategic
relationships; economic conditions including interest and currency exchange
rate fluctuations; changes in generally accepted accounting principles;
trade buying patterns; the impact of legislation and regulatory compliance;
risks and uncertainties associated with global operations and sales; and
other risks and uncertainties, including those detailed from time to time
in our periodic reports filed with the Securities and Exchange Commission,
including our current reports on Form 8-K, quarterly reports on Form 10-Q
and annual report on Form 10-K, particularly the discussion under the
caption "Item 1A, Risk Factors" in our Annual Report on Form 10-K for the
year ended December 31, 2007, which was filed with the Securities and
Exchange Commission on February 29, 2008. The forward-looking statements in
this press release are qualified by these risk factors. We assume no
obligation to publicly update any forward-looking statements, whether as a
result of new information, future developments or otherwise.
Wyeth Pharmaceuticals
wyeth
division of Wyeth (NYSE: WYE), announced that the U.S. Food and Drug
Administration (FDA) issued an approvable letter on May 21 for
bazedoxifene, a selective estrogen receptor modulator, for the treatment of
postmenopausal osteoporosis. In the letter, the FDA requested information
similar to that outlined in its approvable letter for bazedoxifene's New
Drug Application (NDA) for the prevention of postmenopausal osteoporosis
issued in December 2007. This included further analyses concerning the
incidence of stroke and venous thrombotic events. The Agency also
identified specific questions concerning data collection and reporting and
requested additional source documents.
"Today's action is in line with our expectations," says Gary L. Stiles,
M.D., Executive Vice President, Chief Medical Officer, Wyeth
Pharmaceuticals. "In our conference with the Agency earlier this year, they
stated their desire to convene an advisory committee to review the pending
new drug applications for both treatment and prevention of postmenopausal
osteoporosis. We have been working closely with the FDA to address their
questions and we are preparing a complete response which we expect to file
by end of 2008. We remain committed to pursuing bazedoxifene as an
important new option for the millions of postmenopausal women at risk for
osteoporotic fracture."
About Osteoporosis
Osteoporosis is a disease characterized by low bone mass and structural
deterioration of bone tissue, leading to bone fragility and an increased
risk of fractures. According to the National Osteoporosis Foundation, the
number of women of menopausal age who have osteoporosis or are at risk for
developing the disease will increase from almost 30 million in 2002 to
nearly 41 million in 2020. Up to 20 percent of a woman's expected lifetime
bone loss can occur in the years immediately following menopause. The
treatment of postmenopausal osteoporosis could lead to significant
improvement in the overall health for millions of women worldwide as well
as reduce costs associated with postmenopausal osteoporosis-related
fractures.
About Wyeth Pharmaceuticals
Wyeth Pharmaceuticals, a division of Wyeth, has leading products in the
areas of women's health care, infectious disease, gastrointestinal health,
central nervous system, inflammation, transplantation, hemophilia,
oncology, vaccines and nutritional products.
Wyeth is one of the world's largest research-driven pharmaceutical and
health care products companies. It is a leader in the discovery,
development, manufacturing and marketing of pharmaceuticals, vaccines,
biotechnology products, nutritionals and non-prescription medicines that
improve the quality of life for people worldwide. The Company's major
divisions include Wyeth Pharmaceuticals, Wyeth Consumer Healthcare and Fort
Dodge Animal Health.
The statements in this press release that are not historical facts are
forward-looking statements that are subject to risks and uncertainties that
could cause actual results to differ materially from those expressed or
implied by such statements. These risks and uncertainties include, without
limitation, the inherent uncertainty of the timing and success of, and
expense associated with, research, development, regulatory approval and
commercialization of our products and pipeline products (including that
there can be no assurance that our pending new drug applications for
bazedoxifene will be approved or that the product will ever be successfully
commercialized); government cost-containment initiatives; restrictions on
third-party payments for our products; substantial competition in our
industry, including from branded and generic products; emerging data on our
products and pipeline products; the importance of strong performance from
our principal products and our anticipated new product introductions; the
highly regulated nature of our business; product liability, intellectual
property and other litigation risks and environmental liabilities;
uncertainty regarding our intellectual property rights and those of others;
difficulties associated with, and regulatory compliance with respect to,
manufacturing of our products; risks associated with our strategic
relationships; economic conditions including interest and currency exchange
rate fluctuations; changes in generally accepted accounting principles;
trade buying patterns; the impact of legislation and regulatory compliance;
risks and uncertainties associated with global operations and sales; and
other risks and uncertainties, including those detailed from time to time
in our periodic reports filed with the Securities and Exchange Commission,
including our current reports on Form 8-K, quarterly reports on Form 10-Q
and annual report on Form 10-K, particularly the discussion under the
caption "Item 1A, Risk Factors" in our Annual Report on Form 10-K for the
year ended December 31, 2007, which was filed with the Securities and
Exchange Commission on February 29, 2008. The forward-looking statements in
this press release are qualified by these risk factors. We assume no
obligation to publicly update any forward-looking statements, whether as a
result of new information, future developments or otherwise.
Wyeth Pharmaceuticals
wyeth
пятница, 14 октября 2011 г.
New Prospective Multicenter Long-Term Balloon Kyphoplasty Study To Be Featured On American Health Radio
Kyphon Inc. (Nasdaq: KYPH) announced today that Richard Mott, Kyphon's president and
chief executive officer, and Dr. Rudolph Buckley, orthopaedic spine surgeon
from Slocum Dickson Medical Group in Utica, New York, will be interviewed
on American Health Radio, the nationally-syndicated health radio program
hosted by Scott Broder. Dr. Buckley is co-author of the first-ever
prospective multicenter long-term clinical study evaluating the benefits of
balloon kyphoplasty treatment of osteoporotic spinal fractures. This study
was recently published in the September 1, 2006 issue of Spine, the leading
subspecialty, peer-reviewed journal reporting on spinal disorders.
The program will air live today, Monday, October 2, 2006 at 6:00 p.m.
Central Time and can be accessed at wrmn1410. A replay of
the program will be available on Wednesday, October 4 at 8:00 p.m. Central
Time and on Friday, October 6 at 6:00 p.m. Central Time at
healthradionetwork.
This latest study in the growing body of evidence for balloon
kyphoplasty showed that patients experienced rapid and sustained
improvement in back pain, back function and quality of life for two years
post-procedure. In addition, the study documented improvements in restoring
vertebral height and high patient satisfaction with the procedure. To view
a Multimedia News Release, which reveals details about the study, please
visit prnewswire/mnr/kyphon/25116.
Spinal Fractures and Balloon Kyphoplasty
The majority of spinal fractures are caused by osteoporosis, a
progressive disease that causes bones to become brittle, weak and
susceptible to painful, debilitating fractures. According to the National
Osteoporosis Foundation, one-in-two women and one-in-four men over the age
of 50 in the U.S. will experience a spinal fracture, with two-thirds going
undiagnosed. Cancer, including multiple myeloma and the metastasis of other
tumors to bone, can also affect bone quality and lead to spinal fracture.
In cases of multiple spinal fractures, a loss of height and stooped posture
-- known as kyphosis -- can occur, which affects the ability to stand
upright and walk, and can make simple tasks like lifting a bag of groceries
or getting dressed difficult. Left untreated, each additional fracture
increases future fracture risk, accelerating the effects of the spinal
deformity. Increasing kyphosis is associated with decreased respiratory
function, reduced ability to walk, decreased quality of life, and an
increased risk of early mortality.
Supplemental calcium with vitamin D and prescription medications are
often used to slow down bone loss and treat the underlying osteoporosis.
Medical management, however, does not always prevent fracture. Despite the
advances in drug therapy, spinal fractures continue to occur and may
require surgical intervention. First performed in 1998, balloon kyphoplasty
is a minimally invasive procedure which can treat the fracture, reduce
pain, restore quality of life, and repair some or all of the associated
deformity. To date, over 275,000 spinal fractures have been treated using
balloon kyphoplasty worldwide.
To request a full copy of the study, go to
kyphon/professionals/pcpnewsletterrequests.cfm.
To find a Spine Specialist who performs Balloon Kyphoplasty in your
area, go to kyphon/phys_Locator.cfm.
For additional downloadable media materials, go to
kyphon/media.cfm.
About Kyphon Inc
Kyphon develops and markets medical devices designed to restore spinal
function using minimally invasive technologies. The company's KyphX line of
products is used in balloon kyphoplasty, a minimally invasive procedure to
treat spinal fractures caused by osteoporosis or cancer. For more
information, visit Kyphon's Web site at kyphon.
Kyphon and KyphX are registered trademarks of Kyphon Inc
Kyphon Inc
kyphon
chief executive officer, and Dr. Rudolph Buckley, orthopaedic spine surgeon
from Slocum Dickson Medical Group in Utica, New York, will be interviewed
on American Health Radio, the nationally-syndicated health radio program
hosted by Scott Broder. Dr. Buckley is co-author of the first-ever
prospective multicenter long-term clinical study evaluating the benefits of
balloon kyphoplasty treatment of osteoporotic spinal fractures. This study
was recently published in the September 1, 2006 issue of Spine, the leading
subspecialty, peer-reviewed journal reporting on spinal disorders.
The program will air live today, Monday, October 2, 2006 at 6:00 p.m.
Central Time and can be accessed at wrmn1410. A replay of
the program will be available on Wednesday, October 4 at 8:00 p.m. Central
Time and on Friday, October 6 at 6:00 p.m. Central Time at
healthradionetwork.
This latest study in the growing body of evidence for balloon
kyphoplasty showed that patients experienced rapid and sustained
improvement in back pain, back function and quality of life for two years
post-procedure. In addition, the study documented improvements in restoring
vertebral height and high patient satisfaction with the procedure. To view
a Multimedia News Release, which reveals details about the study, please
visit prnewswire/mnr/kyphon/25116.
Spinal Fractures and Balloon Kyphoplasty
The majority of spinal fractures are caused by osteoporosis, a
progressive disease that causes bones to become brittle, weak and
susceptible to painful, debilitating fractures. According to the National
Osteoporosis Foundation, one-in-two women and one-in-four men over the age
of 50 in the U.S. will experience a spinal fracture, with two-thirds going
undiagnosed. Cancer, including multiple myeloma and the metastasis of other
tumors to bone, can also affect bone quality and lead to spinal fracture.
In cases of multiple spinal fractures, a loss of height and stooped posture
-- known as kyphosis -- can occur, which affects the ability to stand
upright and walk, and can make simple tasks like lifting a bag of groceries
or getting dressed difficult. Left untreated, each additional fracture
increases future fracture risk, accelerating the effects of the spinal
deformity. Increasing kyphosis is associated with decreased respiratory
function, reduced ability to walk, decreased quality of life, and an
increased risk of early mortality.
Supplemental calcium with vitamin D and prescription medications are
often used to slow down bone loss and treat the underlying osteoporosis.
Medical management, however, does not always prevent fracture. Despite the
advances in drug therapy, spinal fractures continue to occur and may
require surgical intervention. First performed in 1998, balloon kyphoplasty
is a minimally invasive procedure which can treat the fracture, reduce
pain, restore quality of life, and repair some or all of the associated
deformity. To date, over 275,000 spinal fractures have been treated using
balloon kyphoplasty worldwide.
To request a full copy of the study, go to
kyphon/professionals/pcpnewsletterrequests.cfm.
To find a Spine Specialist who performs Balloon Kyphoplasty in your
area, go to kyphon/phys_Locator.cfm.
For additional downloadable media materials, go to
kyphon/media.cfm.
About Kyphon Inc
Kyphon develops and markets medical devices designed to restore spinal
function using minimally invasive technologies. The company's KyphX line of
products is used in balloon kyphoplasty, a minimally invasive procedure to
treat spinal fractures caused by osteoporosis or cancer. For more
information, visit Kyphon's Web site at kyphon.
Kyphon and KyphX are registered trademarks of Kyphon Inc
Kyphon Inc
kyphon
вторник, 11 октября 2011 г.
UC San Diego Bioengineer's Sticky Insights Published In Journal Science
Sticky is good. A University of California, San Diego bioengineer is the first author on an article in the journal Science that provides insights on the "stickiness of life." The big idea is that cells, tissues and organisms hailing from all limbs of the tree of life respond to stimuli using basic biological "modules." For example, the researchers outlined similar strategies across biology for fulfilling the tasks of "sticking together" (cell-cell interactions), "sticking to their surroundings" (cell-extracellular matrix [ECM] interactions), and responding to forces.
Adam Engler, a bioengineering assistant professor from UC San Diego's Jacobs School of Engineering, is the first author of the Review article entitled "Multiscale Modeling of Form and Function" published in the 10 April issue of the journal Science. According to Engler, there is something inherent in the nature of the ever-present tasks of sticking together and responding to forces that causes common form and function to emerge. For example, even though the cells within bacteria, fungi, sponges, nematodes and humans do not use exactly the same proteins to stick together, all of these organisms rely on fundamental components of cell-cell adhesions for survival. For this reason, the capacity to form complex multilayer organisms through cell-cell interactions is likely based on the evolutionary advantage to adhere to new environments and survive in potentially hostile environments, the authors say.
The team also described a universal need for cells, tissues, organs and organisms to respond to forces. Two examples of very different biological structures that nevertheless rely on responsiveness to forces for proper function are leg bones and breast acini. Breast acini are hollow spherical objects at the ends of breast ducts that are made of a layer of cells that secrete milk proteins. Breast acini form hollow spheres, according to Engler, because this form maximizes the surface to volume ratio. When pressure builds up, acini can hold more and more volume until they need to push the milk proteins down the duct.
"This kind of structure is conserved in a variety of dissimilar systems that respond to forces in a manner similar," said Engler. The long bones of the human skeleton are another example, where their elongated and cylindrical form optimizes the distribution of body weight while remaining very light.
Thinking Wide
Engler hopes that the observations and connections he and his coauthors make regarding the ubiquitous need for vastly different cells, tissues, organs and organisms to use common biological modules will encourage other scientists and engineers to think beyond their specific areas of specialization.
"In our Science paper, I think we have arrived at an interesting way to describe known biological processes and bring concepts together that are traditionally not considered," said Engler. "I hope this paper will encourage researchers to interact with disciplines previously assumed to be dissimilar and foster new interdisciplinary interactions like we have here at UCSD with the Institute for Engineering in Medicine."
Engler's primary appointment is in the Department of Bioengineering at UC San Diego's Jacobs School of Engineering. The Department of Bioengineering ranks 2nd in the nation for biomedical engineering, according to the latest US News rankings. The bioengineering department has ranked among the top five programs in the nation every year for the past decade.
Engler has secondary appointments in Material Science and Biomedical Sciences. He is a member of the UCSD Stem Cell Institute and the UCSD Institute for Engineering in Medicine.
Engler is a bioengineer and mechanical engineer by training. He earned a Ph.D. in mechanical engineering from the University of Pennsylvania, and went on to a post doctoral fellowship in molecular biology at Princeton University before coming to UC San Diego in 2008. He is already involved in a number of interdisciplinary collaborations at UC San Diego.
One collaboration involves Engler, Shu Chien, who is University Professor of Bioengineering and Medicine, and Director of UC San Diego's Institute of Engineering in Medicine (IEM), and materials science professor Sungho Jin from the Jacobs School of Engineering's Mechanical and Aerospace Engineering (MAE) and NanoEngineering departments. In a January 2009 paper in the journal PNAS, researchers led by this team unveiled a new way to help accelerate bone growth through the use of nanotubes and stem cells. This new finding could lead to quicker and better recovery, for example, for patients who undergo orthopedic surgery.
Engler's lab recently began a collaboration with Rick Lieber, Ph.D., Professor and Vice Chair of UC San Diego's Department of Orthopedic Surgery and Director of the National Center for Skeletal Muscle Rehabilitation Research, based at UC San Diego. Lieber is also Senior Research Career Scientist at the Veterans Affairs San Diego Health System. The team is trying to uncover the cause of unexplained lower back pain in patients with no obvious disk degeneration, pinched nerves or other known causes of lower back pain.
"No matter what your area of expertise, there is someone that has a complementary area of expertise that can really help you ask new and interesting questions," said Engler.
Interdisciplinary Research
Mathematicians, engineers and stem cell biologists have not traditionally worked together, but these kinds of interdisciplinary collaborations have been the key to developing new techniques and new disciplines, explained Engler, who told a story of how his own dabbling into interdisciplinary research led to fruitful results.
As a graduate student, Engler helped put an experimental stem-cell-based surgical technique into a more appropriate mechanical context. The project began when he was approached by a surgeon puzzled by the results he was getting after injecting stem cells into damaged rat heart tissue in hopes of regenerating healthy heart tissue.
"As a matrix biologist and a mechanical engineer I said, 'Perhaps we need to look at what the host tissue is actually doing. What is being damaged and what is changing within the tissue due to the lack of oxygen?'" Engler and his collaborators found the cells in the damaged heart tissue were excreting collagen and making stiff scar tissue. "The engineer in me then analyzed the mechanical properties of the tissue and found out it was three to four times more rigid than the background healthy muscle. The biologist in me then characterized the cells in vitro and was able to show that these cells do respond to the mechanical properties of their environment."
Engler published his findings in 2006 in the high profile journal Cell and in the American Journal of Physiology. (Read New Scientist's description of Engler's findings.) One idea for improving such cell-based therapies, according to Engler, could involve injecting "smarter stem cells" that have been programmed to respond to some environmental stimuli but ignore other stimuli.
Notes:
"Multiscale Modeling of Form and Function, by Adam J. Engler from the University of California, San Diego; Patrick O. Humbert from Peter MacCallum Cancer Center; Bernhard Wehrle-Haller from Centre Medical Universitaire; and Valerie M. Weaver from University of California, San Francisco.
Source:
Daniel Kane
University of California - San Diego
Adam Engler, a bioengineering assistant professor from UC San Diego's Jacobs School of Engineering, is the first author of the Review article entitled "Multiscale Modeling of Form and Function" published in the 10 April issue of the journal Science. According to Engler, there is something inherent in the nature of the ever-present tasks of sticking together and responding to forces that causes common form and function to emerge. For example, even though the cells within bacteria, fungi, sponges, nematodes and humans do not use exactly the same proteins to stick together, all of these organisms rely on fundamental components of cell-cell adhesions for survival. For this reason, the capacity to form complex multilayer organisms through cell-cell interactions is likely based on the evolutionary advantage to adhere to new environments and survive in potentially hostile environments, the authors say.
The team also described a universal need for cells, tissues, organs and organisms to respond to forces. Two examples of very different biological structures that nevertheless rely on responsiveness to forces for proper function are leg bones and breast acini. Breast acini are hollow spherical objects at the ends of breast ducts that are made of a layer of cells that secrete milk proteins. Breast acini form hollow spheres, according to Engler, because this form maximizes the surface to volume ratio. When pressure builds up, acini can hold more and more volume until they need to push the milk proteins down the duct.
"This kind of structure is conserved in a variety of dissimilar systems that respond to forces in a manner similar," said Engler. The long bones of the human skeleton are another example, where their elongated and cylindrical form optimizes the distribution of body weight while remaining very light.
Thinking Wide
Engler hopes that the observations and connections he and his coauthors make regarding the ubiquitous need for vastly different cells, tissues, organs and organisms to use common biological modules will encourage other scientists and engineers to think beyond their specific areas of specialization.
"In our Science paper, I think we have arrived at an interesting way to describe known biological processes and bring concepts together that are traditionally not considered," said Engler. "I hope this paper will encourage researchers to interact with disciplines previously assumed to be dissimilar and foster new interdisciplinary interactions like we have here at UCSD with the Institute for Engineering in Medicine."
Engler's primary appointment is in the Department of Bioengineering at UC San Diego's Jacobs School of Engineering. The Department of Bioengineering ranks 2nd in the nation for biomedical engineering, according to the latest US News rankings. The bioengineering department has ranked among the top five programs in the nation every year for the past decade.
Engler has secondary appointments in Material Science and Biomedical Sciences. He is a member of the UCSD Stem Cell Institute and the UCSD Institute for Engineering in Medicine.
Engler is a bioengineer and mechanical engineer by training. He earned a Ph.D. in mechanical engineering from the University of Pennsylvania, and went on to a post doctoral fellowship in molecular biology at Princeton University before coming to UC San Diego in 2008. He is already involved in a number of interdisciplinary collaborations at UC San Diego.
One collaboration involves Engler, Shu Chien, who is University Professor of Bioengineering and Medicine, and Director of UC San Diego's Institute of Engineering in Medicine (IEM), and materials science professor Sungho Jin from the Jacobs School of Engineering's Mechanical and Aerospace Engineering (MAE) and NanoEngineering departments. In a January 2009 paper in the journal PNAS, researchers led by this team unveiled a new way to help accelerate bone growth through the use of nanotubes and stem cells. This new finding could lead to quicker and better recovery, for example, for patients who undergo orthopedic surgery.
Engler's lab recently began a collaboration with Rick Lieber, Ph.D., Professor and Vice Chair of UC San Diego's Department of Orthopedic Surgery and Director of the National Center for Skeletal Muscle Rehabilitation Research, based at UC San Diego. Lieber is also Senior Research Career Scientist at the Veterans Affairs San Diego Health System. The team is trying to uncover the cause of unexplained lower back pain in patients with no obvious disk degeneration, pinched nerves or other known causes of lower back pain.
"No matter what your area of expertise, there is someone that has a complementary area of expertise that can really help you ask new and interesting questions," said Engler.
Interdisciplinary Research
Mathematicians, engineers and stem cell biologists have not traditionally worked together, but these kinds of interdisciplinary collaborations have been the key to developing new techniques and new disciplines, explained Engler, who told a story of how his own dabbling into interdisciplinary research led to fruitful results.
As a graduate student, Engler helped put an experimental stem-cell-based surgical technique into a more appropriate mechanical context. The project began when he was approached by a surgeon puzzled by the results he was getting after injecting stem cells into damaged rat heart tissue in hopes of regenerating healthy heart tissue.
"As a matrix biologist and a mechanical engineer I said, 'Perhaps we need to look at what the host tissue is actually doing. What is being damaged and what is changing within the tissue due to the lack of oxygen?'" Engler and his collaborators found the cells in the damaged heart tissue were excreting collagen and making stiff scar tissue. "The engineer in me then analyzed the mechanical properties of the tissue and found out it was three to four times more rigid than the background healthy muscle. The biologist in me then characterized the cells in vitro and was able to show that these cells do respond to the mechanical properties of their environment."
Engler published his findings in 2006 in the high profile journal Cell and in the American Journal of Physiology. (Read New Scientist's description of Engler's findings.) One idea for improving such cell-based therapies, according to Engler, could involve injecting "smarter stem cells" that have been programmed to respond to some environmental stimuli but ignore other stimuli.
Notes:
"Multiscale Modeling of Form and Function, by Adam J. Engler from the University of California, San Diego; Patrick O. Humbert from Peter MacCallum Cancer Center; Bernhard Wehrle-Haller from Centre Medical Universitaire; and Valerie M. Weaver from University of California, San Francisco.
Source:
Daniel Kane
University of California - San Diego
суббота, 8 октября 2011 г.
Actemra Is First Biologic Agent To Show Better Efficacy Than Methotrexate In RA
PARIS: The interleukin-6 receptor inhibitor Actemra (tocilizumab) achieves significantly greater reduction in the signs and symptoms of rheumatoid arthritis (RA) than the current standard of care, methotrexate, according to two international clinical trials reported this week at EULAR 2008, the Annual European Congress of Rheumatology.
The phase III AMBITION (Actemra versus Methotrexate double-Blind Investigative Trial In mONotherapy) trial randomised 673 patients with active moderate to severe RA, including a high proportion of patients with early disease, to Actemra (8mg/kg) or methotrexate.
Results showed significantly greater reduction in the signs and symptoms of RA at six months in patients treated with Actemra than in those given methotrexate. Nearly three-quarters (70%) of patients treated with Actemra achieved a 20% reduction in their symptoms (ACR20) after 24 weeks, compared to 53% of those treated with methotrexate. No previous biologic therapy has demonstrated superior efficacy to methotrexate in this key measure of RA symptoms by six months.
Nearly three times as many patients treated with the Actemra achieved remission of their RA - defined by the globally recognised measure of Disease Activity Score (DAS) 28 < 2.6 - compared to those taking methotrexate (34% vs 12%). Remission is the ultimate goal in the treatment of RA.
Reporting the results, Professor Graeme Jones, Professor of Rheumatology, University of Tasmania, Hobart, Australia and lead investigator of the study, said: "Tocilizumab demonstrated superior efficacy to methotrexate across a range of measures of RA signs and symptoms. It is the first and only biologic agent that has demonstrated clinical superiority compared to methotrexate as monotherapy."
Asked what treatment he would want to take if diagnosed with RA, Professor Jones said: "Last year, I would have said methotrexate plus an anti-TNF agent, starting on day one. But based on the new data with tocilizumab showing that, as monotherapy, it achieves equivalent efficacy, I wouldn't mind taking this from day one." He added that it had been easy to tell which patients were on Actemra in the trial, as their improvements in RA symptoms were so rapid and dramatic.
Results from a second major study with Actemra showed that the IL-6 receptor inhibitor was also highly effective in difficult-to-treat RA patients who had previously had an inadequate response to anti-tumour necrosis factor drugs (anti-TNFs).
The RADIATE (Research on Actemra Determining effIcacy after Anti-TNF FailurEs) randomised 499 patients with moderate to severe active RA and an inadequate response to at least one anti-TNF drug to Actemra (8 or 4mg/kg) or placebo, in combination with 10-25mg methotrexate.
Half (50%) of patients treated with Actemra (8mg/kg) plus methotrexate achieved an ACR20, compared with 10% of those in the control group. Disease remission (DAS28
The phase III AMBITION (Actemra versus Methotrexate double-Blind Investigative Trial In mONotherapy) trial randomised 673 patients with active moderate to severe RA, including a high proportion of patients with early disease, to Actemra (8mg/kg) or methotrexate.
Results showed significantly greater reduction in the signs and symptoms of RA at six months in patients treated with Actemra than in those given methotrexate. Nearly three-quarters (70%) of patients treated with Actemra achieved a 20% reduction in their symptoms (ACR20) after 24 weeks, compared to 53% of those treated with methotrexate. No previous biologic therapy has demonstrated superior efficacy to methotrexate in this key measure of RA symptoms by six months.
Nearly three times as many patients treated with the Actemra achieved remission of their RA - defined by the globally recognised measure of Disease Activity Score (DAS) 28 < 2.6 - compared to those taking methotrexate (34% vs 12%). Remission is the ultimate goal in the treatment of RA.
Reporting the results, Professor Graeme Jones, Professor of Rheumatology, University of Tasmania, Hobart, Australia and lead investigator of the study, said: "Tocilizumab demonstrated superior efficacy to methotrexate across a range of measures of RA signs and symptoms. It is the first and only biologic agent that has demonstrated clinical superiority compared to methotrexate as monotherapy."
Asked what treatment he would want to take if diagnosed with RA, Professor Jones said: "Last year, I would have said methotrexate plus an anti-TNF agent, starting on day one. But based on the new data with tocilizumab showing that, as monotherapy, it achieves equivalent efficacy, I wouldn't mind taking this from day one." He added that it had been easy to tell which patients were on Actemra in the trial, as their improvements in RA symptoms were so rapid and dramatic.
Results from a second major study with Actemra showed that the IL-6 receptor inhibitor was also highly effective in difficult-to-treat RA patients who had previously had an inadequate response to anti-tumour necrosis factor drugs (anti-TNFs).
The RADIATE (Research on Actemra Determining effIcacy after Anti-TNF FailurEs) randomised 499 patients with moderate to severe active RA and an inadequate response to at least one anti-TNF drug to Actemra (8 or 4mg/kg) or placebo, in combination with 10-25mg methotrexate.
Half (50%) of patients treated with Actemra (8mg/kg) plus methotrexate achieved an ACR20, compared with 10% of those in the control group. Disease remission (DAS28
среда, 5 октября 2011 г.
How Often Do Hip And Knee Replacements Need Revision?
A comprehensive study using nationwide data on hip and knee replacements in England has found that one in seventy-five patients require a revision of
their joint replacement after three years. Although this compares favourably with the rest of the world, the study published in this week's PLoS
Medicine reinforces concerns about the new surgical techniques of hip resurfacing and unicondylar knee replacement.
Hip and knee replacements are amongst the most frequent surgical operations performed, with around 160,000 carried out in England and Wales in 2006.
However, there is little evidence to compare the patient outcomes of hip and knee replacement with the many types of surgical techniques and
prostheses used to replace the joint. Jan van der Meulen and colleagues from the Royal College of Surgeons used records from the National Joint
Registry (NJR) for England and Wales to address this lack of evidence; the NJR being the largest national joint registry of any in the world. Since it
was established in April 2003 the NJR has collected data available immediately following surgery, including patient characteristics, the type of
prostheses and the surgical technique used to replace the joint, with the aim of providing patients, healthcare professionals and regulators with
evidence to assess these prostheses and techniques.
In order to identify the revision rates - how often the hip or knee replacement had to be re-done - the researchers linked the NJR records with
another database: the Hospital Episodes Statistics (HES), which contains information on all admissions to National Health Service (NHS) hospitals in
England. They considered revisions for any reason in the three years following a hip or knee replacement. They also paid particular attention to hip
resurfacing and unicondylar knee replacement, two techniques that are increasingly used but about which there is little evidence of their performance.
Hip resurfacing was introduced in the 1990s for younger patients or those with less severe disease. Rather than replacing the head of the femur, as
happens in total hip replacement, the diseased surface of the joint is replaced with a metal component. In unicondylar knee replacement only the
damaged part of the knee is replaced and it also results in shorter recovery time.
Of the 167,076 procedures that could be linked between the two databases between April 2003 and September 2006 - about half of all such operations
carried out in England in this period - one in seventy-five patients required a revision of their joint replacement, which is considered to be low. As
expected the patients who had cemented prostheses - cement being used to position the metal implant in place in the original replacement surgery - had
the lowest revision rates. For hip replacements the highest revision rates were experienced by women who had undergone hip resurfacing rather than
total joint replacement. Of patients who had undergone knee replacement operations, those who had unicondylar prostheses had the highest revision
rates. According to the study there appears to be no connection between a patient's age and revision rates for hip replacements, whereas revision
rates after knee replacement decreased strongly with age.
The study demonstrates what can be achieved by linking together the two databases and it shows convincing success rates of knee and hip replacement
surgery, with few patients requiring a revision. However, on the basis of the data, the researchers suggest that "consideration should be given to
using hip resurfacing only in male patients and unicondylar knee replacement only in elderly patients." They point out that different patterns may
emerge over a longer follow-up period, so it is not possible to directly draw conclusions on the long-term efficacy of the different procedures.
However, this first national study on joint replacement does provide benchmark data for the further research that is needed to evaluate the
performance of different procedures and types of implant.
Revision rates after primary hip and knee replacement in England between 2003 and 2006.
Sibanda N, Copley LP, Lewsey JD, Borroff M, Gregg P, et al. (2008)
PLoS Med 5(8): e179. doi:10.1371/journal.pmed.0050179
Click here to view article online.
About PLoS Medicine
PLoS Medicine is an open access, freely available international medical journal. It publishes original research that enhances our understanding of
human health and disease, together with commentary and analysis of important global health issues.
PLoS Medicine
About the Public Library of Science
The Public Library of Science (PLoS) is a non-profit organization of scientists and physicians committed to making the world's scientific and medical
literature a freely available public resource.
Public Library of Science
their joint replacement after three years. Although this compares favourably with the rest of the world, the study published in this week's PLoS
Medicine reinforces concerns about the new surgical techniques of hip resurfacing and unicondylar knee replacement.
Hip and knee replacements are amongst the most frequent surgical operations performed, with around 160,000 carried out in England and Wales in 2006.
However, there is little evidence to compare the patient outcomes of hip and knee replacement with the many types of surgical techniques and
prostheses used to replace the joint. Jan van der Meulen and colleagues from the Royal College of Surgeons used records from the National Joint
Registry (NJR) for England and Wales to address this lack of evidence; the NJR being the largest national joint registry of any in the world. Since it
was established in April 2003 the NJR has collected data available immediately following surgery, including patient characteristics, the type of
prostheses and the surgical technique used to replace the joint, with the aim of providing patients, healthcare professionals and regulators with
evidence to assess these prostheses and techniques.
In order to identify the revision rates - how often the hip or knee replacement had to be re-done - the researchers linked the NJR records with
another database: the Hospital Episodes Statistics (HES), which contains information on all admissions to National Health Service (NHS) hospitals in
England. They considered revisions for any reason in the three years following a hip or knee replacement. They also paid particular attention to hip
resurfacing and unicondylar knee replacement, two techniques that are increasingly used but about which there is little evidence of their performance.
Hip resurfacing was introduced in the 1990s for younger patients or those with less severe disease. Rather than replacing the head of the femur, as
happens in total hip replacement, the diseased surface of the joint is replaced with a metal component. In unicondylar knee replacement only the
damaged part of the knee is replaced and it also results in shorter recovery time.
Of the 167,076 procedures that could be linked between the two databases between April 2003 and September 2006 - about half of all such operations
carried out in England in this period - one in seventy-five patients required a revision of their joint replacement, which is considered to be low. As
expected the patients who had cemented prostheses - cement being used to position the metal implant in place in the original replacement surgery - had
the lowest revision rates. For hip replacements the highest revision rates were experienced by women who had undergone hip resurfacing rather than
total joint replacement. Of patients who had undergone knee replacement operations, those who had unicondylar prostheses had the highest revision
rates. According to the study there appears to be no connection between a patient's age and revision rates for hip replacements, whereas revision
rates after knee replacement decreased strongly with age.
The study demonstrates what can be achieved by linking together the two databases and it shows convincing success rates of knee and hip replacement
surgery, with few patients requiring a revision. However, on the basis of the data, the researchers suggest that "consideration should be given to
using hip resurfacing only in male patients and unicondylar knee replacement only in elderly patients." They point out that different patterns may
emerge over a longer follow-up period, so it is not possible to directly draw conclusions on the long-term efficacy of the different procedures.
However, this first national study on joint replacement does provide benchmark data for the further research that is needed to evaluate the
performance of different procedures and types of implant.
Revision rates after primary hip and knee replacement in England between 2003 and 2006.
Sibanda N, Copley LP, Lewsey JD, Borroff M, Gregg P, et al. (2008)
PLoS Med 5(8): e179. doi:10.1371/journal.pmed.0050179
Click here to view article online.
About PLoS Medicine
PLoS Medicine is an open access, freely available international medical journal. It publishes original research that enhances our understanding of
human health and disease, together with commentary and analysis of important global health issues.
PLoS Medicine
About the Public Library of Science
The Public Library of Science (PLoS) is a non-profit organization of scientists and physicians committed to making the world's scientific and medical
literature a freely available public resource.
Public Library of Science
воскресенье, 2 октября 2011 г.
Some Patients May Be Spared An Unnecessary Procedure By New Test For Joint Infection
A potential diagnostic test that could help surgeons confirm or rule out the presence of infection-causing bacteria in prosthetic joints that require surgical revision has been developed by researchers at the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), a part of the National Institutes of Health (NIH). Such a test could spare a subgroup of people who need the surgery a time-consuming and costly treatment for infection, while helping to ensure that people who need the procedure get it. The test is described in the March issue of the Journal of Bone and Joint Surgery.
Each year, hundreds of thousands of joint replacement surgeries are performed in this country. And each year, thousands of them must be revised (the prosthetic joint must be removed and replaced) due to severe pain and swelling. These symptoms are often due to infection, says Rocky S. Tuan, Ph.D., chief of NIAMS' Cartilage Biology and Orthopaedics Branch.
The standard treatment for suspected infection is to remove the joint prosthesis and replace it with a spacer that has been impregnated with antibiotics. After about six weeks, patients must undergo another surgery to remove the spacer. Only then can the surgeon implant the new prosthesis.
The problem with this approach is that confirming the presence of infection-causing bacteria is an inexact science. Currently, doctors check for infection by culturing a sample of the joint fluid. A positive culture confirms live bacteria, making spacer surgery a certainty. A negative culture, however, does not necessarily mean there is no infection. In fact, Tuan says that estimates of the false negative rate for joint cultures in revision surgeries range from 27 percent to 50 percent. But because failure to treat an infected joint could lead to severe infection and limb amputation, spacer surgery is sometimes performed for safety's sake even when infection test results are inconclusive.
To get around the false-negative problem, Tuan and his colleagues developed a way to test for joint infections using polymerase chain reaction (PCR), which detects the presence of bacterial DNA. However, this approach proved to have pitfalls, too. It picked up all bacteria - even dead or dying bacteria that cannot perpetuate infection - thereby giving false positives.
Tuan says this new problem led them to expand their PCR approach by testing for bacterial messenger ribonucleic acid (mRNA). "When bacteria are dying, their mRNA is one of the first things to go," he says. As a result, the researchers hypothesized that a good mRNA test would not only detect bacteria, but would likely tell them if any bacteria they detected were still viable. Unlike DNA, mRNA is not directly quantifiable by known techniques, so the mRNA test that Tuan's group developed employs a process called reverse transcription PCR (RT-PCR) to convert the mRNA into DNA for measurement.
Tuan's group tested the validity of their new method by introducing bacteria into infection-free joint fluid to simulate infection. To ensure that the bacteria were indeed present, they used the PCR test, which accurately showed the amount of bacterial DNA. The researchers then treated the joint fluid cultures with potent antibiotics designed to kill off the bacteria. As expected, the PCR-DNA test still showed that the fluid contained plenty of bacteria, but when the group analyzed the cultures with the RT-PCR test for mRNA, they found that the viable bacteria population was declining.
Now Tuan's team is recruiting 50 people who need joint revision for a clinical trial that will involve testing patients' joint fluid for bacteria and then following them for 6 months to a year after surgery. They hope that the results from this study will validate the protocol to identify or rule out infections before a person begins a surgical revision.
Tuan would like to be able to tell patients who need infection treatment, "There is a really bad infection and we know what to do."
"But we also want to tell the person without infection that it's O.K. to put in a revision joint. That saves the spacer, the additional surgery and its associated risk, and 6 weeks of being laid up," Tuan says.
The mission of the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), a part of the Department of Health and Human Services' National Institutes of Health (NIH), is to support research into the causes, treatment, and prevention of arthritis and musculoskeletal and skin diseases; the training of basic and clinical scientists to carry out this research; and the dissemination of information on research progress in these diseases. For more information about NIAMS, visit the NIAMS Web site at niams.nih/.
The National Institutes of Health (NIH) - The Nation's Medical Research Agency - includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. It is the primary federal agency for conducting and supporting basic, clinical and translational medical research, and it investigates the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit nih/.
Reference:
Birmingham P et al. Simulated joint infection assessment by rapid detection of live bacteria with real-time reverse transcription polymerase chain reaction. J Bone Joint Surg Am 2008;90:602-08.
Source: Trish Reynolds
NIH/National Institute of Arthritis and Musculoskeletal and Skin Diseases
Each year, hundreds of thousands of joint replacement surgeries are performed in this country. And each year, thousands of them must be revised (the prosthetic joint must be removed and replaced) due to severe pain and swelling. These symptoms are often due to infection, says Rocky S. Tuan, Ph.D., chief of NIAMS' Cartilage Biology and Orthopaedics Branch.
The standard treatment for suspected infection is to remove the joint prosthesis and replace it with a spacer that has been impregnated with antibiotics. After about six weeks, patients must undergo another surgery to remove the spacer. Only then can the surgeon implant the new prosthesis.
The problem with this approach is that confirming the presence of infection-causing bacteria is an inexact science. Currently, doctors check for infection by culturing a sample of the joint fluid. A positive culture confirms live bacteria, making spacer surgery a certainty. A negative culture, however, does not necessarily mean there is no infection. In fact, Tuan says that estimates of the false negative rate for joint cultures in revision surgeries range from 27 percent to 50 percent. But because failure to treat an infected joint could lead to severe infection and limb amputation, spacer surgery is sometimes performed for safety's sake even when infection test results are inconclusive.
To get around the false-negative problem, Tuan and his colleagues developed a way to test for joint infections using polymerase chain reaction (PCR), which detects the presence of bacterial DNA. However, this approach proved to have pitfalls, too. It picked up all bacteria - even dead or dying bacteria that cannot perpetuate infection - thereby giving false positives.
Tuan says this new problem led them to expand their PCR approach by testing for bacterial messenger ribonucleic acid (mRNA). "When bacteria are dying, their mRNA is one of the first things to go," he says. As a result, the researchers hypothesized that a good mRNA test would not only detect bacteria, but would likely tell them if any bacteria they detected were still viable. Unlike DNA, mRNA is not directly quantifiable by known techniques, so the mRNA test that Tuan's group developed employs a process called reverse transcription PCR (RT-PCR) to convert the mRNA into DNA for measurement.
Tuan's group tested the validity of their new method by introducing bacteria into infection-free joint fluid to simulate infection. To ensure that the bacteria were indeed present, they used the PCR test, which accurately showed the amount of bacterial DNA. The researchers then treated the joint fluid cultures with potent antibiotics designed to kill off the bacteria. As expected, the PCR-DNA test still showed that the fluid contained plenty of bacteria, but when the group analyzed the cultures with the RT-PCR test for mRNA, they found that the viable bacteria population was declining.
Now Tuan's team is recruiting 50 people who need joint revision for a clinical trial that will involve testing patients' joint fluid for bacteria and then following them for 6 months to a year after surgery. They hope that the results from this study will validate the protocol to identify or rule out infections before a person begins a surgical revision.
Tuan would like to be able to tell patients who need infection treatment, "There is a really bad infection and we know what to do."
"But we also want to tell the person without infection that it's O.K. to put in a revision joint. That saves the spacer, the additional surgery and its associated risk, and 6 weeks of being laid up," Tuan says.
The mission of the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), a part of the Department of Health and Human Services' National Institutes of Health (NIH), is to support research into the causes, treatment, and prevention of arthritis and musculoskeletal and skin diseases; the training of basic and clinical scientists to carry out this research; and the dissemination of information on research progress in these diseases. For more information about NIAMS, visit the NIAMS Web site at niams.nih/.
The National Institutes of Health (NIH) - The Nation's Medical Research Agency - includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. It is the primary federal agency for conducting and supporting basic, clinical and translational medical research, and it investigates the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit nih/.
Reference:
Birmingham P et al. Simulated joint infection assessment by rapid detection of live bacteria with real-time reverse transcription polymerase chain reaction. J Bone Joint Surg Am 2008;90:602-08.
Source: Trish Reynolds
NIH/National Institute of Arthritis and Musculoskeletal and Skin Diseases
четверг, 29 сентября 2011 г.
Study Of Medical Tourism: The Case For And Against
Medical tourism is to go under the microscope in a major new study, led by an academic from the University of York, which aims to assess its potential advantages and disadvantages.
The study, which is funded by the National Institute for Health Research, will examine the motives people have for travelling across national boundaries to receive treatments such as dental services, elective surgery for hip or joint replacement, cosmetic surgery and fertility treatment.
Dr Neil Lunt, of the York Management School, will head a team of researchers that includes health economists, social scientists and clinicians who will research four aspects of medical tourism.
They will spend 18 months studying:
economic impact
consumerism and patient decision-making
quality, safety and risk
industry development.
Medical tourism is currently mainly privately funded and the researchers will seek to establish the amount people are paying for this healthcare and its economic impact. They will also examine the potential savings for the NHS that contracting out treatments to other countries might bring.
But this will be linked to a review of potentially negative impacts on the NHS, such as the need to ensure continuity of care for people who have been treated abroad and the cost of treating complications.
The research team will explore how patients make their decisions concerning treatments and destinations, what information they use - such as websites, friends, internet chat rooms - and how informed their choices are. Patients will also be asked about their experiences of treatment abroad.
Dr Lunt said: "We will advance knowledge of patient treatment experience and how consumers think about choice, and how risk and safety are managed at the consumer and organisational levels.
"Our work will contribute towards understanding quality, administrative and legal dimensions of medical tourism as well as unintended consequences. The study will be of interest to those working within and making decisions about the NHS, policy-makers, regulators, providers, clinicians and consumer organisations as well as patients."
The research team includes Professor Stephen T Green of Sheffield Teaching Hospitals Foundation NHS Trust; Dr Mark Exworthy of the School of Management at Royal Holloway, University of London; Professor Russell Mannion of the Health Services Management Centre at the University of Birmingham and Professor Richard Smith, of the Department of Global Health and Development, London School of Hygiene & Tropical Medicine.
Source:
David Garner
University of York
The study, which is funded by the National Institute for Health Research, will examine the motives people have for travelling across national boundaries to receive treatments such as dental services, elective surgery for hip or joint replacement, cosmetic surgery and fertility treatment.
Dr Neil Lunt, of the York Management School, will head a team of researchers that includes health economists, social scientists and clinicians who will research four aspects of medical tourism.
They will spend 18 months studying:
economic impact
consumerism and patient decision-making
quality, safety and risk
industry development.
Medical tourism is currently mainly privately funded and the researchers will seek to establish the amount people are paying for this healthcare and its economic impact. They will also examine the potential savings for the NHS that contracting out treatments to other countries might bring.
But this will be linked to a review of potentially negative impacts on the NHS, such as the need to ensure continuity of care for people who have been treated abroad and the cost of treating complications.
The research team will explore how patients make their decisions concerning treatments and destinations, what information they use - such as websites, friends, internet chat rooms - and how informed their choices are. Patients will also be asked about their experiences of treatment abroad.
Dr Lunt said: "We will advance knowledge of patient treatment experience and how consumers think about choice, and how risk and safety are managed at the consumer and organisational levels.
"Our work will contribute towards understanding quality, administrative and legal dimensions of medical tourism as well as unintended consequences. The study will be of interest to those working within and making decisions about the NHS, policy-makers, regulators, providers, clinicians and consumer organisations as well as patients."
The research team includes Professor Stephen T Green of Sheffield Teaching Hospitals Foundation NHS Trust; Dr Mark Exworthy of the School of Management at Royal Holloway, University of London; Professor Russell Mannion of the Health Services Management Centre at the University of Birmingham and Professor Richard Smith, of the Department of Global Health and Development, London School of Hygiene & Tropical Medicine.
Source:
David Garner
University of York
понедельник, 26 сентября 2011 г.
A Sporting Chance For Active Total Knee Replacement Patients
Total knee arthroplasty (TKA) patients may be able to participate in high-impact sports without increasing risk of early implant failure, according to a new study presented at the 2010 Annual Meeting of the American Academy of Orthopaedic Surgeons (AAOS). In addition, the authors observed better clinical scores in the group of patients who participated in activities discouraged by the Knee Society (KS) than those of the control group.
The Knee Society recommends TKA patients avoid activities that cause high stress loads on the implant and may increase the risk of early failure. Such activities include high-impact aerobics, football, soccer, baseball, basketball, jogging and power lifting, among others.
"Recent studies have shown that as many as one in six total knee replacement patients participate in non-recommended activities," said Sebastian Parratte, M.D., PhD, an orthopaedic surgeon from the Mayo Clinic in Rochester, MN and the Aix-Marseille University, Center for Arthritis Surgery, Hospital Sainte-Marguerite in Marseille, France. "This study offers some reassurance to those patients who choose to return to an active lifestyle after surgery."
Researchers evaluated outcomes of 218 patients between the ages of 18 and 90 who underwent primary knee arthroplasty at the Mayo Clinic and reported performing heavy manual labor or practicing a non-recommended sport following surgery. The "sport group" was matched by age, gender and BMI to a control group of 317 patients who underwent the same procedure using an identical implant and followed recommended activity guidelines.
Clinical and radiologic results were measured using Knee Society (KS) scores and implant survivorship was evaluated using multivariate analysis according to the Cox model.
At an average follow-up of seven-and-a-half years after surgery, the study found:
No significant radiological differences and no significant differences in implant durability could be demonstrated between the sport group and the control group;
The sport group showed slightly higher KS Knee and function scores compared to the control group;
The control group experienced a 20 percent higher revision rate for mechanical failure (loosening, wear or fracture) compared to the sport group;
After accounting for all variables, including co-morbidities, the sport group had a 10 percent higher risk of mechanical failure compared to the control group.
These results were quite surprising to Dr. Parratte and his team.
"We hypothesized that high-impact activities would not increase the risk of implant failure, but we did not foresee that such activities might actually improve clinical results," he said. "It is clear that more research is necessary to evaluate the short and long-term effect of high-impact activities on the durability and function of modern TKA implants."
He added that, although the industry is not ready or able at this point to revise its recommendations, that possibility may exist in the not-too-distant future. In the meantime, he noted that surgeons and patients should continue to follow all industry recommendations relating to recovery following joint replacement surgery.
About Joint Replacement
Joint replacement, also known as arthroplasty, is considered by many to be one of the most successful medical innovations of the 20th century. Total joint replacement is a surgical procedure in which the patient's natural joint is replaced with an artificial one, made of a combination of plastic, metal, and/or ceramic.
The most common reasons for this surgery are pain and stiffness that limits normal activities such as walking and bending and that cannot be satisfactorily treated with medications or other therapies. Therefore, joint replacement surgery often provides a significantly improved quality of life to patients who would otherwise have to live with severe pain.
In 2007, there were 550,161 total knee replacements performed in the United States, and that number is on the rise - particularly as the Baby Boomer population continues to age. Because of this trend, it is important to optimize patient outcomes.
Disclosure:
Dr. Parratte and his co-authors received no compensation for this study.
Source:
Lauren L. Pearson
American Academy of Orthopaedic Surgeons
The Knee Society recommends TKA patients avoid activities that cause high stress loads on the implant and may increase the risk of early failure. Such activities include high-impact aerobics, football, soccer, baseball, basketball, jogging and power lifting, among others.
"Recent studies have shown that as many as one in six total knee replacement patients participate in non-recommended activities," said Sebastian Parratte, M.D., PhD, an orthopaedic surgeon from the Mayo Clinic in Rochester, MN and the Aix-Marseille University, Center for Arthritis Surgery, Hospital Sainte-Marguerite in Marseille, France. "This study offers some reassurance to those patients who choose to return to an active lifestyle after surgery."
Researchers evaluated outcomes of 218 patients between the ages of 18 and 90 who underwent primary knee arthroplasty at the Mayo Clinic and reported performing heavy manual labor or practicing a non-recommended sport following surgery. The "sport group" was matched by age, gender and BMI to a control group of 317 patients who underwent the same procedure using an identical implant and followed recommended activity guidelines.
Clinical and radiologic results were measured using Knee Society (KS) scores and implant survivorship was evaluated using multivariate analysis according to the Cox model.
At an average follow-up of seven-and-a-half years after surgery, the study found:
No significant radiological differences and no significant differences in implant durability could be demonstrated between the sport group and the control group;
The sport group showed slightly higher KS Knee and function scores compared to the control group;
The control group experienced a 20 percent higher revision rate for mechanical failure (loosening, wear or fracture) compared to the sport group;
After accounting for all variables, including co-morbidities, the sport group had a 10 percent higher risk of mechanical failure compared to the control group.
These results were quite surprising to Dr. Parratte and his team.
"We hypothesized that high-impact activities would not increase the risk of implant failure, but we did not foresee that such activities might actually improve clinical results," he said. "It is clear that more research is necessary to evaluate the short and long-term effect of high-impact activities on the durability and function of modern TKA implants."
He added that, although the industry is not ready or able at this point to revise its recommendations, that possibility may exist in the not-too-distant future. In the meantime, he noted that surgeons and patients should continue to follow all industry recommendations relating to recovery following joint replacement surgery.
About Joint Replacement
Joint replacement, also known as arthroplasty, is considered by many to be one of the most successful medical innovations of the 20th century. Total joint replacement is a surgical procedure in which the patient's natural joint is replaced with an artificial one, made of a combination of plastic, metal, and/or ceramic.
The most common reasons for this surgery are pain and stiffness that limits normal activities such as walking and bending and that cannot be satisfactorily treated with medications or other therapies. Therefore, joint replacement surgery often provides a significantly improved quality of life to patients who would otherwise have to live with severe pain.
In 2007, there were 550,161 total knee replacements performed in the United States, and that number is on the rise - particularly as the Baby Boomer population continues to age. Because of this trend, it is important to optimize patient outcomes.
Disclosure:
Dr. Parratte and his co-authors received no compensation for this study.
Source:
Lauren L. Pearson
American Academy of Orthopaedic Surgeons
пятница, 23 сентября 2011 г.
Early ACL Surgery In Kids Would Save $30 Million & Prevent Thousands Of Secondary Injuries
Nearly $30 million a year would be saved in hospital charges if early rather than delayed ACL (anterior cruciate ligament) reconstruction surgery was performed on pediatric patients, according to a study presented at the American Orthopaedic Society for Sports Medicine's (AOSSM) Annual Meeting in Providence, Rhode Island. Additionally, more than 7,300 tears to the meniscus and 7,800 cartilage tears in children could be avoided each year in the U.S. by early ACL surgery.
"The timing of pediatric and adolescent ACL surgery has historically been controversial," said Theodore J. Ganley, MD, Director of Sports Medicine and Associate Professor at the Children's Hospital of Philadelphia. "The theoretical risks of growth disturbance in younger patients are balanced against the risk of further knee damage related to delaying treatment until closer to skeletal maturity."
The goal of ACL knee surgery is to stabilize the knee allowing patients get back to a healthy, active lifestyle. Long-term, the surgery aims to prevent instability and additional damage to the knee.
A 14-year review of ACL reconstructions presented by the authors at the 2009 AOSSM Annual Meeting revealed a 4 to 11-fold increase in meniscal and cartilage injuries with a greater than 12 week delay in ACL treatment.
In the current study, a model for pediatric ACL reconstruction was developed based on probabilities derived from the ACL review. Identical groups of 100,000 patients, representative of the U.S. population were simulated to undergo either early or delayed ACL reconstruction, with the secondary meniscal and cartilage damage and hospital charges compared between the two groups.
"The decision tree and statistical modeling approach for the study created by my co-author Suneel Bhat, is unique in that it incorporates variability, thereby generating a model simulation of a large scale prospective study, which provides a way to generalize implications," said Dr. Ganley. The simulation found that in females in the U.S., delaying ACL reconstruction beyond 12 weeks resulted in 1,560 medial meniscal tears and 2,100 cartilage tears relative to early surgery each year. In males, delayed surgery resulted in 3,300 medial meniscal tears and 5,720 cartilage tears relative to early surgery.
The study revealed that more than $29.4 million would be saved in hospital charges for pediatric patients each year in the U.S. by reconstructing ACL tears early rather than delaying treatment.
Source:
Lisa Weisenberger
American Orthopaedic Society for Sports Medicine
"The timing of pediatric and adolescent ACL surgery has historically been controversial," said Theodore J. Ganley, MD, Director of Sports Medicine and Associate Professor at the Children's Hospital of Philadelphia. "The theoretical risks of growth disturbance in younger patients are balanced against the risk of further knee damage related to delaying treatment until closer to skeletal maturity."
The goal of ACL knee surgery is to stabilize the knee allowing patients get back to a healthy, active lifestyle. Long-term, the surgery aims to prevent instability and additional damage to the knee.
A 14-year review of ACL reconstructions presented by the authors at the 2009 AOSSM Annual Meeting revealed a 4 to 11-fold increase in meniscal and cartilage injuries with a greater than 12 week delay in ACL treatment.
In the current study, a model for pediatric ACL reconstruction was developed based on probabilities derived from the ACL review. Identical groups of 100,000 patients, representative of the U.S. population were simulated to undergo either early or delayed ACL reconstruction, with the secondary meniscal and cartilage damage and hospital charges compared between the two groups.
"The decision tree and statistical modeling approach for the study created by my co-author Suneel Bhat, is unique in that it incorporates variability, thereby generating a model simulation of a large scale prospective study, which provides a way to generalize implications," said Dr. Ganley. The simulation found that in females in the U.S., delaying ACL reconstruction beyond 12 weeks resulted in 1,560 medial meniscal tears and 2,100 cartilage tears relative to early surgery each year. In males, delayed surgery resulted in 3,300 medial meniscal tears and 5,720 cartilage tears relative to early surgery.
The study revealed that more than $29.4 million would be saved in hospital charges for pediatric patients each year in the U.S. by reconstructing ACL tears early rather than delaying treatment.
Source:
Lisa Weisenberger
American Orthopaedic Society for Sports Medicine
вторник, 20 сентября 2011 г.
Hip, Thigh Implants Can Raise Bone Fracture Risk In Children
Children with hip and thigh implants designed to help heal a broken bone or correct other bone conditions are at risk for subsequent fractures of the very bones that the implants were intended to treat, according to new research from Johns Hopkins Children's Center.
Findings of the Johns Hopkins study, based on an analysis of more than 7,500 pediatric bone implants performed at Hopkins over 15 years, will be presented Feb. 16 at the annual meeting of the American Academy of Orthopaedic Surgeons.
Although the absolute risk among the patients was relatively small - nine out of 1,000 hip and thigh implants were linked to hip and thigh fractures - it was 15 times higher than the risk for implant-related fractures in other bones, the researchers say. They urge orthopedic surgeons to carefully consider removing the implants a few years after surgery or once the bone has healed completely.
Implant related fractures are believed to stem from the pressure and stress that the implant exerts on the bone, especially in patients whose bones are still growing and in those with already weakened or brittle bones from preexisting conditions such as cerebral palsy and some rare skeletal syndromes. Indeed, most of the 25 implant-related fractures in the study occurred in children with such diagnoses.
The investigators note that hip and thigh bones experience the highest stress because their shape changes rapidly during growth, so removing these implants may be especially important for children.
"Removing the implant early and as soon as the bone heals is a wise consideration for all children with hip and thigh implants, but even more so for patients with already vulnerable bone structure," says senior investigator Paul Sponseller, M.D., M.B.A., director of orthopedic surgery at Hopkins Children's.
Thigh implants carried the highest risk - 20 of the 25 fractures observed in the study involved hip and/or thigh implants, or nine fractures per 1,000 such implants. The overall risk for fractures caused by implants in any bone was three per 1,000, while the risk of fracture was less than one per 1,000 in the hand, arm, forearm, leg, ankle and foot bones.
Low-risk implants in healthy children are best left in, the researchers add, because the surgical risks of removing them may outweigh the benefits.
"To remove or not remove an otherwise asymptomatic implant has been a long-standing question in orthopedic surgery, and we hope that our findings will help surgeons and patients make such decisions," Sponseller says.
The average time between implant insertion and fracture was 2.6 years.
Co-investigators on the research included Amit Jain, B.S., Arabella Leet, M.D., and Michael Ain, M.D., all of Hopkins, and Gurkan Erkula, M.D., formerly of Hopkins.
Source:
Johns Hopkins Medicine
Findings of the Johns Hopkins study, based on an analysis of more than 7,500 pediatric bone implants performed at Hopkins over 15 years, will be presented Feb. 16 at the annual meeting of the American Academy of Orthopaedic Surgeons.
Although the absolute risk among the patients was relatively small - nine out of 1,000 hip and thigh implants were linked to hip and thigh fractures - it was 15 times higher than the risk for implant-related fractures in other bones, the researchers say. They urge orthopedic surgeons to carefully consider removing the implants a few years after surgery or once the bone has healed completely.
Implant related fractures are believed to stem from the pressure and stress that the implant exerts on the bone, especially in patients whose bones are still growing and in those with already weakened or brittle bones from preexisting conditions such as cerebral palsy and some rare skeletal syndromes. Indeed, most of the 25 implant-related fractures in the study occurred in children with such diagnoses.
The investigators note that hip and thigh bones experience the highest stress because their shape changes rapidly during growth, so removing these implants may be especially important for children.
"Removing the implant early and as soon as the bone heals is a wise consideration for all children with hip and thigh implants, but even more so for patients with already vulnerable bone structure," says senior investigator Paul Sponseller, M.D., M.B.A., director of orthopedic surgery at Hopkins Children's.
Thigh implants carried the highest risk - 20 of the 25 fractures observed in the study involved hip and/or thigh implants, or nine fractures per 1,000 such implants. The overall risk for fractures caused by implants in any bone was three per 1,000, while the risk of fracture was less than one per 1,000 in the hand, arm, forearm, leg, ankle and foot bones.
Low-risk implants in healthy children are best left in, the researchers add, because the surgical risks of removing them may outweigh the benefits.
"To remove or not remove an otherwise asymptomatic implant has been a long-standing question in orthopedic surgery, and we hope that our findings will help surgeons and patients make such decisions," Sponseller says.
The average time between implant insertion and fracture was 2.6 years.
Co-investigators on the research included Amit Jain, B.S., Arabella Leet, M.D., and Michael Ain, M.D., all of Hopkins, and Gurkan Erkula, M.D., formerly of Hopkins.
Source:
Johns Hopkins Medicine
суббота, 17 сентября 2011 г.
Electronic Health Record-Based Programs Triples Osteoporosis Screening Rate, Study Finds
Use of the Electronic Health Record tripled the rate of osteoporosis screenings in women who are at risk for the disease, according to a study conducted recently by a team of Geisinger Health System researchers.
About half of those who were screened were considered high-risk for the disease, the study found.
An estimated 10 million Americans suffer from the disease and the nation collectively spends about $18 billion per year on bone fractures related to osteoporosis.
EHR-screening programs can help improve those numbers, make patients' everyday lives less painful and save doctors time and resources, said Dr. Eric Newman, Geisinger's Director of Rheumatology.
The EHR was used to identify women who had not had bone density screens for osteoporosis in the last two years. Those women were sent letters and received telephone calls if their records were flagged.
"This is pretty significant," said Dr. William Ayoub of Geisinger Medical Group-Scenery Park, State College, one of the study's authors. "The EHR is streamlining the screening process and letting people know about a potential health concern before it becomes a major problem."
The EHR screening program was started in two Geisinger family practice clinics near State College, Pa. It was so successful that there are now plans to implement the program at other sites throughout the Geisinger system, Newman said.
Geisinger Health System is widely recognized as a leader in EHR implementation and development. Osteoporosis screening is one of the specific areas in which Geisinger has used its fully implemented $70 million Electronic Health Record, Newman said.
"We are clearly out there trying to prevent fractures from occurring," Newman said. "We proactively want to identify women who are at a great risk for osteoporosis."
The study was presented at the American College of Rheumatology's annual meeting in Washington D.C. in November. Just one in 10 papers were accepted for oral presentation at the meeting.
About Geisinger Health System
Geisinger Health System is one of the nation's leading fully integrated healthcare providers. Founded in 1915, Geisinger serves more than two million residents throughout central and northeastern Pennsylvania. The physician-led organization is at the forefront of the country's rapidly emerging electronic health records movement. Geisinger includes three major regional medical centers, a 650-member group practice, a not-for-profit health insurance company, and the Geisinger Center for Health Research-dedicated to creating innovative new models for patient care, satisfaction and clinical outcomes.
Contact: Justin Walden
Geisinger Health System
About half of those who were screened were considered high-risk for the disease, the study found.
An estimated 10 million Americans suffer from the disease and the nation collectively spends about $18 billion per year on bone fractures related to osteoporosis.
EHR-screening programs can help improve those numbers, make patients' everyday lives less painful and save doctors time and resources, said Dr. Eric Newman, Geisinger's Director of Rheumatology.
The EHR was used to identify women who had not had bone density screens for osteoporosis in the last two years. Those women were sent letters and received telephone calls if their records were flagged.
"This is pretty significant," said Dr. William Ayoub of Geisinger Medical Group-Scenery Park, State College, one of the study's authors. "The EHR is streamlining the screening process and letting people know about a potential health concern before it becomes a major problem."
The EHR screening program was started in two Geisinger family practice clinics near State College, Pa. It was so successful that there are now plans to implement the program at other sites throughout the Geisinger system, Newman said.
Geisinger Health System is widely recognized as a leader in EHR implementation and development. Osteoporosis screening is one of the specific areas in which Geisinger has used its fully implemented $70 million Electronic Health Record, Newman said.
"We are clearly out there trying to prevent fractures from occurring," Newman said. "We proactively want to identify women who are at a great risk for osteoporosis."
The study was presented at the American College of Rheumatology's annual meeting in Washington D.C. in November. Just one in 10 papers were accepted for oral presentation at the meeting.
About Geisinger Health System
Geisinger Health System is one of the nation's leading fully integrated healthcare providers. Founded in 1915, Geisinger serves more than two million residents throughout central and northeastern Pennsylvania. The physician-led organization is at the forefront of the country's rapidly emerging electronic health records movement. Geisinger includes three major regional medical centers, a 650-member group practice, a not-for-profit health insurance company, and the Geisinger Center for Health Research-dedicated to creating innovative new models for patient care, satisfaction and clinical outcomes.
Contact: Justin Walden
Geisinger Health System
среда, 14 сентября 2011 г.
DeCODE Discovers Common Genetic Variations Contributing To Low Bone Mineral Density And Risk Of Osteoporosis
Scientists from deCODE genetics (Nasdaq: DCGN) and colleagues from Australia and Denmark report the discovery of common single-letter variations (SNPs) in the human genome linked to low bone mineral density (BMD), the clinical measurement used to diagnose osteoporosis. deCODE had previously identified five sites in the genome harboring SNPs with influence on BMD, and today's study has added four more. They were identified through the correlation of BMD measurements with more than 300,000 SNPs across the genomes of 7,000 study participants in Iceland. The findings were then followed up and replicated in more than 5,000 participants from Denmark and Australia. The paper, "New sequence variants associated with bone mineral density," is published in the online edition of Nature Genetics at nature/ng, and will appear in an upcoming print edition of the journal.
The new variants reported today are located on chromosomes 17q21, 14q32, 12q13 and 18q21. Like the variants previously discovered by deCODE, certain of those reported today are known to be involved in bone and skeletal development. The SNPs on chromosome 17 are adjacent to the SOST gene, which encodes sclerostin, a protein involved in the formation of bone. And the SNP on chromosome 18 lies close to the TNFRSF11A gene that has been implicated in Paget's disease, a disorder causing localized bone deformities and weakness.
"This study expands our understanding of the genetic factors contributing to low bone mineral density, propensity to fractures, and osteoporosis. And the genetics is clearly pointing us toward valuable novel drug targets. The next steps in this work are to analyze how these variants contribute to low BMD and related disorders, and to identify additional common as well as rare variants with a high impact on bone density. Once we do, we may well bring together genetic risk factors accounting for a sufficient proportion of risk of osteoporosis to develop a clinically useful DNA-based risk assessment test. This could be a valuable tool, since peak bone density is achieved by early adulthood. Those at high risk of osteoporosis could therefore take concrete measures including appropriate diet and exercise regimes, to maximize their bone mass in youth and lower their risk of the disease later in life," said Kari Stefansson, CEO of deCODE.
deCODE would like to thank the Icelandic participants, as well as the participants and scientists from the Danish Prospective Epidemiological risk Factor (PERF) study and the Australian Dubbo Osteoporosis Epidemiological Study (DOES), for making this study possible.
About deCODE
deCODE is a bio-pharmaceutical company developing drugs and DNA-based tests to improve the treatment, diagnosis and prevention of common diseases. Its lead therapeutic programs, which leverage the company's expertise in chemistry and structural biology, include DG041, an antiplatelet compound being developed for the prevention of arterial thrombosis; DG051 and DG031, compounds targeting the leukotriene pathway for the prevention of heart attack; and DG071 and a platform for other PDE4 modulators with therapeutic applications in Alzheimer's disease and other conditions. deCODE is a global leader in human genetics, and has identified key variations in the genome (SNPs) conferring increased risk of major public health challenges from cardiovascular disease to cancer. Based upon these discoveries deCODE has brought to market a growing range of DNA-based tests for gauging risk and empowering prevention of common diseases. Through its CLIA-registered laboratory, deCODE is offers deCODE T2(TM) for type 2 diabetes; deCODE AF(TM) for atrial fibrillation and stroke; deCODE MI(TM) for heart attack; deCODE ProstateCancer(TM) for prostate cancer; deCODE Glaucoma(TM) for a major type of glaucoma; and deCODE BreastCancer(TM), for the common forms of breast cancer. deCODE is delivering on the promise of the new genetics.SM Visit us on the web at decode; on our diagnostics site at decodediagnostics; for our pioneering personal genome analysis service, integrating the genetic variants included in these tests and those linked to another twenty common diseases, at decodeme; and on our blog at decodeyou.
Any statements contained in this presentation that relate to future plans, events or performance are forward-looking statements within the meaning of the Private Securities Litigation Reform Act of 1995. These forward-looking statements are subject to a number of risks and uncertainties that could cause actual results, and the timing of events, to differ materially from those described in the forward-looking statements. These risks and uncertainties include, among others, those relating to our ability to obtain financing and to form collaborative relationships, the effect of a potential delisting of our common stock from The Nasdaq Global Market, uncertainty regarding potential future deterioration in the market for auction rate securities which could negatively affect our cash position and result in additional permanent impairment charges, our ability to develop and market diagnostic products, the level of third party reimbursement for our products, risks related to preclinical and clinical development of pharmaceutical products, including the identification of compounds and the completion of clinical trials, the effect of government regulation and the regulatory approval processes, market acceptance, our ability to obtain and protect intellectual property rights for our products, dependence on collaborative relationships, the effect of competitive products, industry trends and other risks identified in deCODE's filings with the Securities and Exchange Commission, including, without limitation, the risk factors identified in our most recent Annual Report on Form 10-K and any updates to those risk factors filed from time to time in our Quarterly Reports on Form 10-Q or Current Reports on Form 8-K. deCODE undertakes no obligation to update or alter these forward-looking statements as a result of new information, future events or otherwise.
deCODE genetics Inc
decode
The new variants reported today are located on chromosomes 17q21, 14q32, 12q13 and 18q21. Like the variants previously discovered by deCODE, certain of those reported today are known to be involved in bone and skeletal development. The SNPs on chromosome 17 are adjacent to the SOST gene, which encodes sclerostin, a protein involved in the formation of bone. And the SNP on chromosome 18 lies close to the TNFRSF11A gene that has been implicated in Paget's disease, a disorder causing localized bone deformities and weakness.
"This study expands our understanding of the genetic factors contributing to low bone mineral density, propensity to fractures, and osteoporosis. And the genetics is clearly pointing us toward valuable novel drug targets. The next steps in this work are to analyze how these variants contribute to low BMD and related disorders, and to identify additional common as well as rare variants with a high impact on bone density. Once we do, we may well bring together genetic risk factors accounting for a sufficient proportion of risk of osteoporosis to develop a clinically useful DNA-based risk assessment test. This could be a valuable tool, since peak bone density is achieved by early adulthood. Those at high risk of osteoporosis could therefore take concrete measures including appropriate diet and exercise regimes, to maximize their bone mass in youth and lower their risk of the disease later in life," said Kari Stefansson, CEO of deCODE.
deCODE would like to thank the Icelandic participants, as well as the participants and scientists from the Danish Prospective Epidemiological risk Factor (PERF) study and the Australian Dubbo Osteoporosis Epidemiological Study (DOES), for making this study possible.
About deCODE
deCODE is a bio-pharmaceutical company developing drugs and DNA-based tests to improve the treatment, diagnosis and prevention of common diseases. Its lead therapeutic programs, which leverage the company's expertise in chemistry and structural biology, include DG041, an antiplatelet compound being developed for the prevention of arterial thrombosis; DG051 and DG031, compounds targeting the leukotriene pathway for the prevention of heart attack; and DG071 and a platform for other PDE4 modulators with therapeutic applications in Alzheimer's disease and other conditions. deCODE is a global leader in human genetics, and has identified key variations in the genome (SNPs) conferring increased risk of major public health challenges from cardiovascular disease to cancer. Based upon these discoveries deCODE has brought to market a growing range of DNA-based tests for gauging risk and empowering prevention of common diseases. Through its CLIA-registered laboratory, deCODE is offers deCODE T2(TM) for type 2 diabetes; deCODE AF(TM) for atrial fibrillation and stroke; deCODE MI(TM) for heart attack; deCODE ProstateCancer(TM) for prostate cancer; deCODE Glaucoma(TM) for a major type of glaucoma; and deCODE BreastCancer(TM), for the common forms of breast cancer. deCODE is delivering on the promise of the new genetics.SM Visit us on the web at decode; on our diagnostics site at decodediagnostics; for our pioneering personal genome analysis service, integrating the genetic variants included in these tests and those linked to another twenty common diseases, at decodeme; and on our blog at decodeyou.
Any statements contained in this presentation that relate to future plans, events or performance are forward-looking statements within the meaning of the Private Securities Litigation Reform Act of 1995. These forward-looking statements are subject to a number of risks and uncertainties that could cause actual results, and the timing of events, to differ materially from those described in the forward-looking statements. These risks and uncertainties include, among others, those relating to our ability to obtain financing and to form collaborative relationships, the effect of a potential delisting of our common stock from The Nasdaq Global Market, uncertainty regarding potential future deterioration in the market for auction rate securities which could negatively affect our cash position and result in additional permanent impairment charges, our ability to develop and market diagnostic products, the level of third party reimbursement for our products, risks related to preclinical and clinical development of pharmaceutical products, including the identification of compounds and the completion of clinical trials, the effect of government regulation and the regulatory approval processes, market acceptance, our ability to obtain and protect intellectual property rights for our products, dependence on collaborative relationships, the effect of competitive products, industry trends and other risks identified in deCODE's filings with the Securities and Exchange Commission, including, without limitation, the risk factors identified in our most recent Annual Report on Form 10-K and any updates to those risk factors filed from time to time in our Quarterly Reports on Form 10-Q or Current Reports on Form 8-K. deCODE undertakes no obligation to update or alter these forward-looking statements as a result of new information, future events or otherwise.
deCODE genetics Inc
decode
воскресенье, 11 сентября 2011 г.
Novel Model Of Osteosarcoma
In the June 15th issue of G&D, Dr. Stuart Orkin (HHMI, Dana-Farber Cancer Institute, Children's Hospital Boston) and colleagues present a new mouse model of osteosarcoma.
Osteosarcoma is the most common type of malignant bone cancer, and one of the most lethal: The 5-year survival rate is only about 60%, and this statistic drops steeply once the cancer spreads. Osteosarcoma results from the dysregulated growth of osteoblasts (the cells that form the bone matrix). It primarily develops near the ends of the femur, tibia or humerus, and is usually diagnosed during adolescence, when the long bones of the body are undergoing rapid growth.
While the precise causes of osteosarcoma are unknown, it is evident that two tumor suppressor genes - p53 and Rb - are involved, as children with familial mutation syndromes affecting either of these genes have higher incidences of osteosarcoma.
Dr. Orkin's team has developed a novel experimental system to model the genetics of human osteosarcoma. The researchers generated a strain of transgenic mice lacking specifically the p53 and Rb genes in an early osteoblast progenitor cell population. All mutant animals rapidly developed osteosarcomas, with clinical, histo-cytological and molecular features closely recapitulating the human disease.
The scientists concluded that p53 loss is essential for the development of osteosarcoma, and that while Rb gene mutation acts synergistically with p53 loss to facilitate carcinogenesis, loss of Rb, alone, is not sufficient to induce osteosarcomagenesis.
Ultimately, this high-fidelity animal model will further elucidate the genetic contributions to osteosarcoma, and enable researchers to rationally design and test new therapies. Dr. Orkin is hopeful that "our work will stimulate translational efforts to develop novel therapies for this devastating bone tumor".
Source: Heather Cosel-Pieper
Cold Spring Harbor Laboratory
Osteosarcoma is the most common type of malignant bone cancer, and one of the most lethal: The 5-year survival rate is only about 60%, and this statistic drops steeply once the cancer spreads. Osteosarcoma results from the dysregulated growth of osteoblasts (the cells that form the bone matrix). It primarily develops near the ends of the femur, tibia or humerus, and is usually diagnosed during adolescence, when the long bones of the body are undergoing rapid growth.
While the precise causes of osteosarcoma are unknown, it is evident that two tumor suppressor genes - p53 and Rb - are involved, as children with familial mutation syndromes affecting either of these genes have higher incidences of osteosarcoma.
Dr. Orkin's team has developed a novel experimental system to model the genetics of human osteosarcoma. The researchers generated a strain of transgenic mice lacking specifically the p53 and Rb genes in an early osteoblast progenitor cell population. All mutant animals rapidly developed osteosarcomas, with clinical, histo-cytological and molecular features closely recapitulating the human disease.
The scientists concluded that p53 loss is essential for the development of osteosarcoma, and that while Rb gene mutation acts synergistically with p53 loss to facilitate carcinogenesis, loss of Rb, alone, is not sufficient to induce osteosarcomagenesis.
Ultimately, this high-fidelity animal model will further elucidate the genetic contributions to osteosarcoma, and enable researchers to rationally design and test new therapies. Dr. Orkin is hopeful that "our work will stimulate translational efforts to develop novel therapies for this devastating bone tumor".
Source: Heather Cosel-Pieper
Cold Spring Harbor Laboratory
четверг, 8 сентября 2011 г.
Cost Effective Relief From Low Back Pain With Acupuncture
Acupuncture has a small but significant benefit for patients with low back pain, and appears to be cost-effective in the longer term, find two studies published on bmj today.
In the UK, an estimated 16% of the adult population consult their general practitioner for help with back pain in a 12-month period. The annual cost of lower back pain to the NHS has been estimated at 480 pounds million (пїЅ703million; $901million) and the burden of lower back pain is estimated at over пїЅ10 billion per year in terms of lost productivity and sickness benefits.
Acupuncture is used by an estimated 2% of adults each year for a range of conditions, including back pain. But the evidence is largely inconclusive and the best way to manage low back pain remains unclear.
So, researchers identified 241 adults aged 18 to 65 with persistent non-specific low back pain. The people were provided by members of the British Acupuncture Council. Patients were randomly assigned to either usual NHS care or up to 10 acupuncture treatment sessions. All patients remained under GP care.
Pain levels were measured at intervals during the two-year study period. Satisfaction with treatment and use of pain medication were also recorded.
At 12 months, patients in the acupuncture group showed a small benefit in pain scores compared to patients receiving usual care. Stronger evidence was observed for an increased benefit at 24 months.
At three months, patients in the acupuncture group were significantly more likely to be 'very satisfied' with their treatment compared with usual care, and with their overall care, but showed no such difference in satisfaction with information received.
At 24 months, the acupuncture group were more likely to report reduced worry about their back pain, less likely to report current use of pain medication for their back, and more likely to report no pain for the past 12 months.
Although the differences in pain scores between groups were small, they represent a clinically worthwhile benefit and can be viewed as a 'moderate' effect, say the authors.
Further research is needed to investigate the optimum timing for such an acupuncture treatment package, and to assess the value of repeated courses of acupuncture for patients experiencing recurrent episodes of low back pain, they conclude.
In a separate paper, the same researchers looked at the cost effectiveness of acupuncture for lower back pain. Costs were measured from both an NHS and a societal perspective, and effectiveness was measured in terms of quality adjusted life years (QALYs) gained.
They found that total NHS costs during the two-year study period were higher on average for the acupuncture group (460 pounds; пїЅ673; $859) than for the usual care group (345 pounds; пїЅ506; $644).
However, the cost per QALY gained was 4,241 pounds (пїЅ6,223; $7,921). This is well below the lower threshold of 20,000 pounds used by the National Institute for Health and Clinical Excellence (NICE) to decide whether the NHS can afford to pay for a health technology.
A short course of traditional acupuncture for the treatment of lower back pain in primary care confers a modest health benefit measured in QALYs for a relatively minor extra NHS cost relative to usual care, say the authors. The use of acupuncture for the treatment of lower back pain therefore appears to be cost-effective in the longer term.
Contact: Emma Dickinson
BMJ-British Medical Journal
In the UK, an estimated 16% of the adult population consult their general practitioner for help with back pain in a 12-month period. The annual cost of lower back pain to the NHS has been estimated at 480 pounds million (пїЅ703million; $901million) and the burden of lower back pain is estimated at over пїЅ10 billion per year in terms of lost productivity and sickness benefits.
Acupuncture is used by an estimated 2% of adults each year for a range of conditions, including back pain. But the evidence is largely inconclusive and the best way to manage low back pain remains unclear.
So, researchers identified 241 adults aged 18 to 65 with persistent non-specific low back pain. The people were provided by members of the British Acupuncture Council. Patients were randomly assigned to either usual NHS care or up to 10 acupuncture treatment sessions. All patients remained under GP care.
Pain levels were measured at intervals during the two-year study period. Satisfaction with treatment and use of pain medication were also recorded.
At 12 months, patients in the acupuncture group showed a small benefit in pain scores compared to patients receiving usual care. Stronger evidence was observed for an increased benefit at 24 months.
At three months, patients in the acupuncture group were significantly more likely to be 'very satisfied' with their treatment compared with usual care, and with their overall care, but showed no such difference in satisfaction with information received.
At 24 months, the acupuncture group were more likely to report reduced worry about their back pain, less likely to report current use of pain medication for their back, and more likely to report no pain for the past 12 months.
Although the differences in pain scores between groups were small, they represent a clinically worthwhile benefit and can be viewed as a 'moderate' effect, say the authors.
Further research is needed to investigate the optimum timing for such an acupuncture treatment package, and to assess the value of repeated courses of acupuncture for patients experiencing recurrent episodes of low back pain, they conclude.
In a separate paper, the same researchers looked at the cost effectiveness of acupuncture for lower back pain. Costs were measured from both an NHS and a societal perspective, and effectiveness was measured in terms of quality adjusted life years (QALYs) gained.
They found that total NHS costs during the two-year study period were higher on average for the acupuncture group (460 pounds; пїЅ673; $859) than for the usual care group (345 pounds; пїЅ506; $644).
However, the cost per QALY gained was 4,241 pounds (пїЅ6,223; $7,921). This is well below the lower threshold of 20,000 pounds used by the National Institute for Health and Clinical Excellence (NICE) to decide whether the NHS can afford to pay for a health technology.
A short course of traditional acupuncture for the treatment of lower back pain in primary care confers a modest health benefit measured in QALYs for a relatively minor extra NHS cost relative to usual care, say the authors. The use of acupuncture for the treatment of lower back pain therefore appears to be cost-effective in the longer term.
Contact: Emma Dickinson
BMJ-British Medical Journal
понедельник, 5 сентября 2011 г.
Eating Broccoli Could Guard Against Arthritis
Scientists at the University of East Anglia (UEA) are launching a groundbreaking new project to investigate the benefits of broccoli in the fight against osteoarthritis.
Initial laboratory research at UEA has found that a compound in broccoli called sulforaphane blocks the enzymes that cause joint destruction in osteoarthritis the most common form of arthritis.
Broccoli has previously been associated with reduced cancer risk but this is the first major study into its effects on joint health.
With funding from both Arthritis Research UK and the Diet and Health Research Industry Club (DRINC), the ВЈ650,000 project will explore how sulforaphane may act to slow or prevent the development of osteoarthritis. It will prepare the way for the first patient trials and could lead to safe new ways of preventing and treating this painful disease.
Sulforaphane is a bioactive compound found in cruciferous vegetables, particularly broccoli. Eating broccoli leads to a high level of sulforaphane in the blood, but scientists don't yet know if the sulforaphane gets into joints in sufficient amounts to be effective. This is one of the things that the UEA team hopes to discover.
Osteoarthritis is the leading cause of disability in the UK where it affects around six million people. It is a degenerative joint disease which gradually destroys the cartilage in the joints, particularly in the hands, feet, spine, hips and knees of older people. There is currently no effective treatment other than pain relief or joint replacement.
Prof Ian Clark, of UEA's School of Biological Sciences, who is leading the research said: "The UK has an aging population and developing new strategies for combating age-related diseases such as osteoarthritis is vital to improve the quality of life for sufferers but also to reduce the economic burden on society."
As part of the three-year project, the UEA team will also investigate the effects of other dietary compounds on osteoarthritis, including diallyl disulphide which is found in high amounts in garlic and also appears to slow the destruction of cartilage in laboratory models.
Source: East Anglia University, AlphaGalileo Foundation.
Initial laboratory research at UEA has found that a compound in broccoli called sulforaphane blocks the enzymes that cause joint destruction in osteoarthritis the most common form of arthritis.
Broccoli has previously been associated with reduced cancer risk but this is the first major study into its effects on joint health.
With funding from both Arthritis Research UK and the Diet and Health Research Industry Club (DRINC), the ВЈ650,000 project will explore how sulforaphane may act to slow or prevent the development of osteoarthritis. It will prepare the way for the first patient trials and could lead to safe new ways of preventing and treating this painful disease.
Sulforaphane is a bioactive compound found in cruciferous vegetables, particularly broccoli. Eating broccoli leads to a high level of sulforaphane in the blood, but scientists don't yet know if the sulforaphane gets into joints in sufficient amounts to be effective. This is one of the things that the UEA team hopes to discover.
Osteoarthritis is the leading cause of disability in the UK where it affects around six million people. It is a degenerative joint disease which gradually destroys the cartilage in the joints, particularly in the hands, feet, spine, hips and knees of older people. There is currently no effective treatment other than pain relief or joint replacement.
Prof Ian Clark, of UEA's School of Biological Sciences, who is leading the research said: "The UK has an aging population and developing new strategies for combating age-related diseases such as osteoarthritis is vital to improve the quality of life for sufferers but also to reduce the economic burden on society."
As part of the three-year project, the UEA team will also investigate the effects of other dietary compounds on osteoarthritis, including diallyl disulphide which is found in high amounts in garlic and also appears to slow the destruction of cartilage in laboratory models.
Source: East Anglia University, AlphaGalileo Foundation.
пятница, 2 сентября 2011 г.
Foot Fashion Could Ease Arthritic Knees
The use of special mobility shoes can help ease knee pain and slow disease progression in people with osteoarthritis, according to research presented this week at the American College of Rheumatology Annual Scientific Meeting in Atlanta.
Osteoarthritis, or OA as it is commonly called, is the most common joint disease affecting middle-age and older people. It is characterized by progressive damage to the joint cartilage the cushioning material at the end of long bones and causes changes in the structures around the joint. These changes can include fluid accumulation, bony overgrowth, and loosening and weakness of muscles and tendons, all of which may limit movement and cause pain and swelling.
"Forces on the knee joint during walking have been shown to be related to pain, severity and progression of knee osteoarthritis," explains Najia Shakoor, MD; associate professor of medicine at Rush University in Chicago and lead investigator in the study. "Therefore, researchers currently investigate strategies to reduce these forces or loads on the knee joint in hopes of preventing progression of the disease." Dr. Shakoor's study recently tested these strategies, more specifically, by studying how the use of mobility shoes flat and flexible shoes, created specifically for this research, that allow natural foot mobility and provide sufficient support for the foot can affect knee OA.
At the beginning of the study, researchers used a special camera system and a force plate to determine gait (how a person walks) in 16 participants (who were all diagnosed with knee OA through X-rays and based on symptoms) while they walked in their own shoes, in mobility shoes, and barefoot. After this initial evaluation, participants were instructed to wear the mobility shoes a minimum of six hours per day, six days a week for six months. To determine the progression of each participant, researchers performed the same gait analysis that was performed at the beginning of the study at six, 12 and 24 weeks.
Overall, researchers determined that mobility shoes, in comparison to conventional shoes, led to significantly decreased knee loads in the participants. Additionally, they found that longer-term use of the mobility shoes led to even better outcomes in participants noting a reduction in knee load that increased from 3.7 percent at the beginning of the study to 9.4 percent after six weeks, and to 18 percent at six months. Finally, researchers found that after 24 weeks of wearing mobility shoes, participants experienced an adaptation in their gait (with a knee load reduction of 11 percent) even when wearing conventional shoes leading researchers to believe that the use of mobility shoes could create beneficial neuromuscular and behavioral changes in how people with OA walk.
"This study showed that specialized footwear was beneficial in reducing knee loads substantially over six months," says Dr. Shakoor. "It is also the first study to show that chronic use of a mechanical, knee-load reducing intervention could lead to favorable alterations in the way participants walk even once the intervention is removed. "
Source: American College of Rheumatology (ACR)
Osteoarthritis, or OA as it is commonly called, is the most common joint disease affecting middle-age and older people. It is characterized by progressive damage to the joint cartilage the cushioning material at the end of long bones and causes changes in the structures around the joint. These changes can include fluid accumulation, bony overgrowth, and loosening and weakness of muscles and tendons, all of which may limit movement and cause pain and swelling.
"Forces on the knee joint during walking have been shown to be related to pain, severity and progression of knee osteoarthritis," explains Najia Shakoor, MD; associate professor of medicine at Rush University in Chicago and lead investigator in the study. "Therefore, researchers currently investigate strategies to reduce these forces or loads on the knee joint in hopes of preventing progression of the disease." Dr. Shakoor's study recently tested these strategies, more specifically, by studying how the use of mobility shoes flat and flexible shoes, created specifically for this research, that allow natural foot mobility and provide sufficient support for the foot can affect knee OA.
At the beginning of the study, researchers used a special camera system and a force plate to determine gait (how a person walks) in 16 participants (who were all diagnosed with knee OA through X-rays and based on symptoms) while they walked in their own shoes, in mobility shoes, and barefoot. After this initial evaluation, participants were instructed to wear the mobility shoes a minimum of six hours per day, six days a week for six months. To determine the progression of each participant, researchers performed the same gait analysis that was performed at the beginning of the study at six, 12 and 24 weeks.
Overall, researchers determined that mobility shoes, in comparison to conventional shoes, led to significantly decreased knee loads in the participants. Additionally, they found that longer-term use of the mobility shoes led to even better outcomes in participants noting a reduction in knee load that increased from 3.7 percent at the beginning of the study to 9.4 percent after six weeks, and to 18 percent at six months. Finally, researchers found that after 24 weeks of wearing mobility shoes, participants experienced an adaptation in their gait (with a knee load reduction of 11 percent) even when wearing conventional shoes leading researchers to believe that the use of mobility shoes could create beneficial neuromuscular and behavioral changes in how people with OA walk.
"This study showed that specialized footwear was beneficial in reducing knee loads substantially over six months," says Dr. Shakoor. "It is also the first study to show that chronic use of a mechanical, knee-load reducing intervention could lead to favorable alterations in the way participants walk even once the intervention is removed. "
Source: American College of Rheumatology (ACR)
вторник, 30 августа 2011 г.
Method For Accelerated Bone Growth Developed By UC San Diego Engineers Develop
Engineers at the University of California at San Diego have come up with a way to help accelerate bone growth through the use of nanotubes and stem cells. This new finding could lead to quicker and better recovery, for example, for patients who undergo orthopedic surgery.
In recent years, stem cells have become a hot topic of investigation with studies suggesting revolutionary medical benefits due to their ability to be converted into selected types of newly generated cells. During their research, the group of UC San Diego bioengineers and material science experts used a nano-bio technology method of placing mesenchymal stem cells on top of very thin titanium oxide nanotubes in order to control the conversion paths, called differentiation, into osteoblasts or bone building cells. Mesenchymal stem cells, which are different from embryonic stem cells, can be extracted and directly supplied from a patient's own bone marrow.
The researchers described their lab findings in a paper published this week in the Proceedings of the National Academy of Sciences (PNAS), "Stem Cell Fate Dictated Solely by Altered Nanotube Dimension."
"If you break your knee or leg from skiing, for example, an orthopedic surgeon will implant a titanium rod, and you will be on crutches for about three months," said Sungho Jin, co-author of the PNAS paper and a materials science professor at the Jacobs School of Engineering. "But what we anticipate through our research is that if the surgeon uses titanium oxide nanotubes with stem cells, the bone healing could be accelerated and a patient may be able to walk in one month instead of being on crunches for three months.
"Our in-vitro and in-vivo data indicate that such advantages can occur by using the titanium oxide nanotube treated implants, which can reduce the loosening of bones, one of the major orthopedic problems that necessitate re-surgery operations for hip and other implants for patients," Jin added. "Such a major re-surgery, especially for older people, is a health risk and significant inconvenience, and is also undesirable from the cost point of view."
This is the first study of its kind using stem cells attached to titanium oxide nanotube implants. Jin and his research team - which include Jacobs School bioengineering professors Shu Chien and Adam Engler, as well as post doctoral researcher Seunghan Oh and other graduate students and researchers - report that the precise change in nanotube diameter can be controlled to induce selective differentiation of stem cells into osteoblast (bone-forming) cells. Karla Brammer, a Jacobs School materials science graduate student, will also present these findings in a poster session during the Jacobs School of Engineering's Research Expo on February 19.
According to this breakthrough research, nanotubes with a larger diameter cause cells growing on their surface to elongate much more than those with a small diameter. The larger diameter nanotube promotes quicker and stronger bone growth. "The use of nano topography to induce preferred differentiation was reported in recent years by other groups, but such studies were done mostly on polymer surfaces, which are not desirable orthopedic implant materials," Jin said.
It is common for physicians and surgeons to use chemicals for stem cell implants in order to control cell differentiation, a conversion into a certain desired type of cells, for example, to neural cells, heart cells, and bone cells. However, introducing chemicals into the human body can sometimes have undesirable side effects. "What we have accomplished here is a way to introduce desirable guided differentiation using only nanostructures instead of resorting to chemicals," said Seunghan (Brian) Oh, who is the lead author of the PNAS article.
The next step for engineers will be to work with orthopedic surgeons and other colleagues at the UC San Diego School of Medicine to study ways to translate this breakthrough research to clinical application, said Shu Chien, a UC San Diego bioengineering professor and director of the university's new Institute of Engineering in Medicine (IEM). Chien said this effort will be fostered by the IEM, whose goal is to bring together scientists, engineers and medical experts to come up with novel approaches to medicine.
"Our research in this area has pointed to a novel way by which we can modulate the stem cell differentiation, which is very important in regenerative medicine," Chien said. "This will lead to a truly interdisciplinary approach between engineering and medicine to getting novel treatments to the clinic to benefit the patients."
Source: Andrea Siedsma
University of California - San Diego
In recent years, stem cells have become a hot topic of investigation with studies suggesting revolutionary medical benefits due to their ability to be converted into selected types of newly generated cells. During their research, the group of UC San Diego bioengineers and material science experts used a nano-bio technology method of placing mesenchymal stem cells on top of very thin titanium oxide nanotubes in order to control the conversion paths, called differentiation, into osteoblasts or bone building cells. Mesenchymal stem cells, which are different from embryonic stem cells, can be extracted and directly supplied from a patient's own bone marrow.
The researchers described their lab findings in a paper published this week in the Proceedings of the National Academy of Sciences (PNAS), "Stem Cell Fate Dictated Solely by Altered Nanotube Dimension."
"If you break your knee or leg from skiing, for example, an orthopedic surgeon will implant a titanium rod, and you will be on crutches for about three months," said Sungho Jin, co-author of the PNAS paper and a materials science professor at the Jacobs School of Engineering. "But what we anticipate through our research is that if the surgeon uses titanium oxide nanotubes with stem cells, the bone healing could be accelerated and a patient may be able to walk in one month instead of being on crunches for three months.
"Our in-vitro and in-vivo data indicate that such advantages can occur by using the titanium oxide nanotube treated implants, which can reduce the loosening of bones, one of the major orthopedic problems that necessitate re-surgery operations for hip and other implants for patients," Jin added. "Such a major re-surgery, especially for older people, is a health risk and significant inconvenience, and is also undesirable from the cost point of view."
This is the first study of its kind using stem cells attached to titanium oxide nanotube implants. Jin and his research team - which include Jacobs School bioengineering professors Shu Chien and Adam Engler, as well as post doctoral researcher Seunghan Oh and other graduate students and researchers - report that the precise change in nanotube diameter can be controlled to induce selective differentiation of stem cells into osteoblast (bone-forming) cells. Karla Brammer, a Jacobs School materials science graduate student, will also present these findings in a poster session during the Jacobs School of Engineering's Research Expo on February 19.
According to this breakthrough research, nanotubes with a larger diameter cause cells growing on their surface to elongate much more than those with a small diameter. The larger diameter nanotube promotes quicker and stronger bone growth. "The use of nano topography to induce preferred differentiation was reported in recent years by other groups, but such studies were done mostly on polymer surfaces, which are not desirable orthopedic implant materials," Jin said.
It is common for physicians and surgeons to use chemicals for stem cell implants in order to control cell differentiation, a conversion into a certain desired type of cells, for example, to neural cells, heart cells, and bone cells. However, introducing chemicals into the human body can sometimes have undesirable side effects. "What we have accomplished here is a way to introduce desirable guided differentiation using only nanostructures instead of resorting to chemicals," said Seunghan (Brian) Oh, who is the lead author of the PNAS article.
The next step for engineers will be to work with orthopedic surgeons and other colleagues at the UC San Diego School of Medicine to study ways to translate this breakthrough research to clinical application, said Shu Chien, a UC San Diego bioengineering professor and director of the university's new Institute of Engineering in Medicine (IEM). Chien said this effort will be fostered by the IEM, whose goal is to bring together scientists, engineers and medical experts to come up with novel approaches to medicine.
"Our research in this area has pointed to a novel way by which we can modulate the stem cell differentiation, which is very important in regenerative medicine," Chien said. "This will lead to a truly interdisciplinary approach between engineering and medicine to getting novel treatments to the clinic to benefit the patients."
Source: Andrea Siedsma
University of California - San Diego
суббота, 27 августа 2011 г.
After Hip Replacement Surgery, Rivaroxaban Better Than Enoxaparin For Preventing VTE
Patients who had complete hip replacement surgery, or total hip
arthroplasty (THA), had better success at preventing venous
thromboembolism if they used extended duration rivaroxaban instead of
short-term enoxaparin plus placebo. The results of the full study by
Professor Ajay Kakkar (Barts and the London School of Medicine and
Dentistry and the Thrombosis Research Institute, London, UK) and
colleagues are published in The Lancet.
Venous thromboembolism (VTE) is a potentially fatal blood clot, and its
risk of occurrence is greater after THA. Standard preventative
treatment includes heparin-based thromboprophylaxis (with enoxaparin)
for about 10 to 35 days after surgery, but this clot-preventing
treatment is rarely used after the patient has left the hospital. For
example, one registry reported that less than 50% of patients received
thromboprophylaxis for at least 28 days. To investigate the efficacy of
a new orally active antithrombotic drug, Kakkar and colleagues
conducted the RECORD2 study.
For patients undergoing THA, the randomized, controlled trial compared
31 to 39 days of the oral antithrombotic drug rivaroxaban with 10 to 14
days of enoxaparin followed by placebo in patients undergoing THA.
Specifically, of 2,509 patients scheduled for THA 1,252 were randomly
assigned to receive oral rivaroxaban 10mg once daily for 31 to 39 days
followed by placebo injection for 10 to 14 days, and 1,257 were
randomly assigned to receive enoxaparin 40mg once daily subcutaneously
for 10 to 14 days followed by placebo tablet for 31 to 39 days. The
researchers focused on deep-vein thrombosis (DVT) measurements as well
as non-fatal pulmonary embolism (NFPE) and death from any cause through
days 30 to 42.
Complete data were obtained for 864 patients in the rivaroxaban group
and 869 in the enoxaparin group. Of key interest were the rates of DVT
for each group: 17 patients (2.0%) in the rivaroxaban group and 81
patients (9.3%) in the enoxaparin group. This translates to an absolute
risk reduction of 7.3% for those patients in the rivaroxaban group, or
a four times greater likelihood that patients in the enoxaparin group
suffer DVT, NFPE, or die. There were no significant differences noted,
however, in bleeding events during treatment.
"Extended thromboprophylaxis with rivaroxaban was significantly more
effective than short-term enoxaparin plus placebo for the prevention of
venous thromboembolism, including symptomatic events, in patients
undergoing total hip arthroplasty," conclude the authors.
An accompanying Comment, written by Dr John Eikelboom and Professor
Jeffrey Weitz (McMaster University, Hamilton, ON, Canada), maintains
that, "With superior efficacy, no compromise in safety, and a
convenient once daily regimen, rivaroxaban seems an obvious choice for
simplified thromboprophylaxis after hip or knee arthroplasty."
Extended duration rivaroxaban versus short-term enoxaparin for
the prevention of venous thromboembolism after total hip arthroplasty:
a double-blind, randomised controlled trial
Ajay K Kakkar, Benjamin Brenner, Ola E Dahl, Bengt I Eriksson, Patrick
Mouret, Jim Muntz, Andrea G Soglian, ГЃkos F Pap, Frank Misselwitz,
Sylvia Haas, for the RECORD2 Investigators
The Lancet (2008).
DOI:10.1016/S0140-6736(08)60880-6
Click
Here to View Journal Website
Written by: Peter M Crosta
arthroplasty (THA), had better success at preventing venous
thromboembolism if they used extended duration rivaroxaban instead of
short-term enoxaparin plus placebo. The results of the full study by
Professor Ajay Kakkar (Barts and the London School of Medicine and
Dentistry and the Thrombosis Research Institute, London, UK) and
colleagues are published in The Lancet.
Venous thromboembolism (VTE) is a potentially fatal blood clot, and its
risk of occurrence is greater after THA. Standard preventative
treatment includes heparin-based thromboprophylaxis (with enoxaparin)
for about 10 to 35 days after surgery, but this clot-preventing
treatment is rarely used after the patient has left the hospital. For
example, one registry reported that less than 50% of patients received
thromboprophylaxis for at least 28 days. To investigate the efficacy of
a new orally active antithrombotic drug, Kakkar and colleagues
conducted the RECORD2 study.
For patients undergoing THA, the randomized, controlled trial compared
31 to 39 days of the oral antithrombotic drug rivaroxaban with 10 to 14
days of enoxaparin followed by placebo in patients undergoing THA.
Specifically, of 2,509 patients scheduled for THA 1,252 were randomly
assigned to receive oral rivaroxaban 10mg once daily for 31 to 39 days
followed by placebo injection for 10 to 14 days, and 1,257 were
randomly assigned to receive enoxaparin 40mg once daily subcutaneously
for 10 to 14 days followed by placebo tablet for 31 to 39 days. The
researchers focused on deep-vein thrombosis (DVT) measurements as well
as non-fatal pulmonary embolism (NFPE) and death from any cause through
days 30 to 42.
Complete data were obtained for 864 patients in the rivaroxaban group
and 869 in the enoxaparin group. Of key interest were the rates of DVT
for each group: 17 patients (2.0%) in the rivaroxaban group and 81
patients (9.3%) in the enoxaparin group. This translates to an absolute
risk reduction of 7.3% for those patients in the rivaroxaban group, or
a four times greater likelihood that patients in the enoxaparin group
suffer DVT, NFPE, or die. There were no significant differences noted,
however, in bleeding events during treatment.
"Extended thromboprophylaxis with rivaroxaban was significantly more
effective than short-term enoxaparin plus placebo for the prevention of
venous thromboembolism, including symptomatic events, in patients
undergoing total hip arthroplasty," conclude the authors.
An accompanying Comment, written by Dr John Eikelboom and Professor
Jeffrey Weitz (McMaster University, Hamilton, ON, Canada), maintains
that, "With superior efficacy, no compromise in safety, and a
convenient once daily regimen, rivaroxaban seems an obvious choice for
simplified thromboprophylaxis after hip or knee arthroplasty."
Extended duration rivaroxaban versus short-term enoxaparin for
the prevention of venous thromboembolism after total hip arthroplasty:
a double-blind, randomised controlled trial
Ajay K Kakkar, Benjamin Brenner, Ola E Dahl, Bengt I Eriksson, Patrick
Mouret, Jim Muntz, Andrea G Soglian, ГЃkos F Pap, Frank Misselwitz,
Sylvia Haas, for the RECORD2 Investigators
The Lancet (2008).
DOI:10.1016/S0140-6736(08)60880-6
Click
Here to View Journal Website
Written by: Peter M Crosta
среда, 24 августа 2011 г.
Young Child With Devastating Bone Disease Walks For First Time After Innovative Operation
An innovative operation using "telescoping rods" performed at Hospital for Special Surgery in Manhattan enabled a young Long Island boy to walk for the first time, and the child and his mother are going to Washington, D.C., to tell their story.
Patricia Vega and her son, Ismael, who turns six this month, have been invited to join Dr. Daniel Green, their orthopedic surgeon, to meet with U.S. Senators and Representatives to personally advocate for the future of musculoskeletal care and continued federal funding for research. The American Academy of Orthopaedic Surgeons is sponsoring the event, and Dr. Green and little Ismael are representing the Pediatric Orthopaedic Society of North America.
Dr. Green, a pediatric orthopedic surgeon at Hospital for Special Surgery, implanted the metal rods into the leg bones of little Ismael, who was born with osteogenesis imperfecta, or OI, which caused his bones to be brittle and weak. An innovation in OI surgery, the telescoping rods get longer as the child grows, avoiding the need for repeated operations.
Before the surgery, Ismael was carried around by his parents or used a stroller. His bones were so fragile that by the time he was three, he had suffered 12 broken bones and more than 100 microfractures. Doctors on Long Island told his mother little could be done. They said Ismael would probably never be able to walk and would spend most of his life in a wheelchair.
But Patricia Vega, who is from Hampton Bays, refused to give up hope. One day, a nurse who was assisting Mrs. Vega in caring for Ismael told her the highly specialized pediatric orthopedic surgeons at Hospital for Special Surgery might be able to help him.
Mrs. Vega went to see Dr. Green, who explained that a newer type of surgery using "telescoping" rods could straighten his bones and enable Ismael to walk. The special rods, implanted in his thigh bones, would extend, in essence, growing along with her child. The surgery, in combination with newer bone-building medicines called bisphosphonates, would give her child his best chance to lead a more normal life.
Mrs. Vega agreed to the operation. Until his surgery at age three, life was tough for little Ismael. As a baby, when he instinctively tried to stand up, his fragile bones could not support his small body, and a bone in his leg would break.
Multiple fractures had caused Ismael's thigh bones to be severely bent. "The x-rays showed that his femur bone, which was supposed to be straight, was bent at 90 degrees," Dr. Green recalled. "His bones were so weak they were having microscopic fractures over and over again, and this led his femur bone to develop these massive deformities or curves. His other thigh bone was bent at 45 degrees."
The surgery entailed placing metal rods in Ismael's bones to make them straight, prevent future fractures and enable him to walk. "Placing rods in the long bones of the legs is one of the most common surgeries performed in patients with OI," Dr. Green said. "The advantage these days is the telescoping rods they're a great advance. In recent years, we've seen excellent results in many cases."
The special rod, which self-elongates as the child grows, eliminates the need for repeated surgeries to change rods as the child gains height. Dr. Green says Special Surgery is one of the few hospitals in the region using the telescoping rod system, and doctors are following patients to see how well it's working.
Ismael's operation was a success. He needed to wear casts from his toes to his hips for five weeks and then had months of intensive physical therapy. But the end result was worth it, Mrs. Vega says. "I have no words to explain how happy I was when Ismael walked for the first time. We feel that Dr. Green was sent from heaven. Without him, Ismael would not be walking."
"There have been tremendous advances in the treatment of OI in the past decade, and Ismael's case is a very positive illustration of what can be done," Dr. Green says. "It's a combination of surgery and medication that has improved the opportunities for children with this disease. I've seen patients in their 40s with OI who, unfortunately, did not have these treatments available when they were children. They have the same type of OI as Ismael, but have spent most of their lives in a wheelchair."
Hospital for Special Surgery (HSS) has one of the largest osteogenesis imperfecta centers in the region and uses a team approach, including orthopedic surgeons, radiologists, nurses and physical therapists. "The team at HSS seeks to educate parents about the disease. We believe education is the key to empowerment," Dr. Green says. "We're very impressed by Mrs. Vega. She's a strong advocate for her child."
Mrs. Vega now speaks to other parents of children with OI to let them know that treatments are available. She's extremely grateful for the care her son received at HSS. "Dr. Green is not just a doctor, he's a person with heart. He treated my son as more than a patient, he treated him as if he were part of his family."
Dr. Green says Ismael has an excellent prognosis. The Vegas have taken him to Disney World since the operation. "I broke down in tears when I saw him walking and going on rides in Orlando, I was so happy," Mrs. Vega said. During their first trip, Ismael experienced Disney World in a stroller and in the arms of his parents. "Before the surgery, I never thought I'd see him walk," she said.
Always an advocate for her child, Mrs. Vega also wants to help others and is very happy to be able to share her son's story with lawmakers during her upcoming trip. "My hope for the future is to discover a cure and to let people know there's a lot of hope for kids with OI."
Source: Hospital for Special Surgery
Patricia Vega and her son, Ismael, who turns six this month, have been invited to join Dr. Daniel Green, their orthopedic surgeon, to meet with U.S. Senators and Representatives to personally advocate for the future of musculoskeletal care and continued federal funding for research. The American Academy of Orthopaedic Surgeons is sponsoring the event, and Dr. Green and little Ismael are representing the Pediatric Orthopaedic Society of North America.
Dr. Green, a pediatric orthopedic surgeon at Hospital for Special Surgery, implanted the metal rods into the leg bones of little Ismael, who was born with osteogenesis imperfecta, or OI, which caused his bones to be brittle and weak. An innovation in OI surgery, the telescoping rods get longer as the child grows, avoiding the need for repeated operations.
Before the surgery, Ismael was carried around by his parents or used a stroller. His bones were so fragile that by the time he was three, he had suffered 12 broken bones and more than 100 microfractures. Doctors on Long Island told his mother little could be done. They said Ismael would probably never be able to walk and would spend most of his life in a wheelchair.
But Patricia Vega, who is from Hampton Bays, refused to give up hope. One day, a nurse who was assisting Mrs. Vega in caring for Ismael told her the highly specialized pediatric orthopedic surgeons at Hospital for Special Surgery might be able to help him.
Mrs. Vega went to see Dr. Green, who explained that a newer type of surgery using "telescoping" rods could straighten his bones and enable Ismael to walk. The special rods, implanted in his thigh bones, would extend, in essence, growing along with her child. The surgery, in combination with newer bone-building medicines called bisphosphonates, would give her child his best chance to lead a more normal life.
Mrs. Vega agreed to the operation. Until his surgery at age three, life was tough for little Ismael. As a baby, when he instinctively tried to stand up, his fragile bones could not support his small body, and a bone in his leg would break.
Multiple fractures had caused Ismael's thigh bones to be severely bent. "The x-rays showed that his femur bone, which was supposed to be straight, was bent at 90 degrees," Dr. Green recalled. "His bones were so weak they were having microscopic fractures over and over again, and this led his femur bone to develop these massive deformities or curves. His other thigh bone was bent at 45 degrees."
The surgery entailed placing metal rods in Ismael's bones to make them straight, prevent future fractures and enable him to walk. "Placing rods in the long bones of the legs is one of the most common surgeries performed in patients with OI," Dr. Green said. "The advantage these days is the telescoping rods they're a great advance. In recent years, we've seen excellent results in many cases."
The special rod, which self-elongates as the child grows, eliminates the need for repeated surgeries to change rods as the child gains height. Dr. Green says Special Surgery is one of the few hospitals in the region using the telescoping rod system, and doctors are following patients to see how well it's working.
Ismael's operation was a success. He needed to wear casts from his toes to his hips for five weeks and then had months of intensive physical therapy. But the end result was worth it, Mrs. Vega says. "I have no words to explain how happy I was when Ismael walked for the first time. We feel that Dr. Green was sent from heaven. Without him, Ismael would not be walking."
"There have been tremendous advances in the treatment of OI in the past decade, and Ismael's case is a very positive illustration of what can be done," Dr. Green says. "It's a combination of surgery and medication that has improved the opportunities for children with this disease. I've seen patients in their 40s with OI who, unfortunately, did not have these treatments available when they were children. They have the same type of OI as Ismael, but have spent most of their lives in a wheelchair."
Hospital for Special Surgery (HSS) has one of the largest osteogenesis imperfecta centers in the region and uses a team approach, including orthopedic surgeons, radiologists, nurses and physical therapists. "The team at HSS seeks to educate parents about the disease. We believe education is the key to empowerment," Dr. Green says. "We're very impressed by Mrs. Vega. She's a strong advocate for her child."
Mrs. Vega now speaks to other parents of children with OI to let them know that treatments are available. She's extremely grateful for the care her son received at HSS. "Dr. Green is not just a doctor, he's a person with heart. He treated my son as more than a patient, he treated him as if he were part of his family."
Dr. Green says Ismael has an excellent prognosis. The Vegas have taken him to Disney World since the operation. "I broke down in tears when I saw him walking and going on rides in Orlando, I was so happy," Mrs. Vega said. During their first trip, Ismael experienced Disney World in a stroller and in the arms of his parents. "Before the surgery, I never thought I'd see him walk," she said.
Always an advocate for her child, Mrs. Vega also wants to help others and is very happy to be able to share her son's story with lawmakers during her upcoming trip. "My hope for the future is to discover a cure and to let people know there's a lot of hope for kids with OI."
Source: Hospital for Special Surgery
воскресенье, 21 августа 2011 г.
Playing With Pain Can Ruin Your Tennis Game
Foot pain began affecting Donna's tennis game, and she was determined not to let it keep her from the sport she loved.
The 47-year-old avid tennis player from Arizona tried to play through the pain and rest her feet between matches. But when the pain became too much, and even started affecting her everyday activities, she made an appointment with a foot and ankle surgeon. His diagnosis: Donna was suffering from plantar fasciitis and a neuroma.
According to Donna's doctor, Kris DiNucci, DPM, FACFAS, a Fellow of the American College of Foot and Ankle Surgeons, the conditions plaguing her are common among court-playing athletes. "Because playing tennis requires quick, repetitive foot movements and continuous forefoot pressure, neuromas, (a thickening of the nerve tissue in the foot from compression) are common," DiNucci says. "In addition, those same movements can cause athletes to develop plantar fasciitis, an inflammation of the strong ligament that extends from the heel to the toes," he added. "If treated early, both conditions can be resolved non-operatively. But as the condition progresses, surgical methods may be required to help patients get back to their sport and their everyday activities."
Donna's treatment regimen included stretching exercises, icing, a cortisone injection, an adjustment to her shoes and custom orthotics. "Within four months the heel pain from the plantar fasciitis had improved tremendously. But the pain in the ball of my foot from the neuroma was still bad and Dr. DiNucci recommended surgery," Donna said.
"While surgery is not always needed to treat neuromas, in Donna's case it was necessary because she wasn't responding to non-surgical treatments," DiNucci said.
Four weeks after surgery, Donna was back on the tennis courts and eight-weeks post-op, she was back to her normal three-to-four day a week tennis game.
Court-playing athletes, such as tennis and basketball players, are also susceptible to Achilles tendonitis, sesamoiditis, stress fractures, ankle sprains and posterior tibial tendonitis, which all can be brought on from the high-impact movements of playing on hard surfaces. "Players with existing foot maladies or structural abnormalities of the lower extremity also need to be extra cautious while playing since their conditions can put them at a higher risk for overuse injury," says Dr. DiNucci.
No matter the sport, athletes must take preventive methods to protect their feet to keep themselves in the game. Supportive shoes tailored to the sport are vital, along with proper training and stretching before and after play. If athletes are injured or experience pain or discomfort in their feet or ankles, it's best to be examined by a foot and ankle surgeon. Early intervention is the key to proper healing.
As for Donna, she's back on her feet and has made modifications to her game, such as stretching before and after a match and wearing more supportive shoes with her orthotics.
Source: American College of Foot and Ankle Surgeons
The 47-year-old avid tennis player from Arizona tried to play through the pain and rest her feet between matches. But when the pain became too much, and even started affecting her everyday activities, she made an appointment with a foot and ankle surgeon. His diagnosis: Donna was suffering from plantar fasciitis and a neuroma.
According to Donna's doctor, Kris DiNucci, DPM, FACFAS, a Fellow of the American College of Foot and Ankle Surgeons, the conditions plaguing her are common among court-playing athletes. "Because playing tennis requires quick, repetitive foot movements and continuous forefoot pressure, neuromas, (a thickening of the nerve tissue in the foot from compression) are common," DiNucci says. "In addition, those same movements can cause athletes to develop plantar fasciitis, an inflammation of the strong ligament that extends from the heel to the toes," he added. "If treated early, both conditions can be resolved non-operatively. But as the condition progresses, surgical methods may be required to help patients get back to their sport and their everyday activities."
Donna's treatment regimen included stretching exercises, icing, a cortisone injection, an adjustment to her shoes and custom orthotics. "Within four months the heel pain from the plantar fasciitis had improved tremendously. But the pain in the ball of my foot from the neuroma was still bad and Dr. DiNucci recommended surgery," Donna said.
"While surgery is not always needed to treat neuromas, in Donna's case it was necessary because she wasn't responding to non-surgical treatments," DiNucci said.
Four weeks after surgery, Donna was back on the tennis courts and eight-weeks post-op, she was back to her normal three-to-four day a week tennis game.
Court-playing athletes, such as tennis and basketball players, are also susceptible to Achilles tendonitis, sesamoiditis, stress fractures, ankle sprains and posterior tibial tendonitis, which all can be brought on from the high-impact movements of playing on hard surfaces. "Players with existing foot maladies or structural abnormalities of the lower extremity also need to be extra cautious while playing since their conditions can put them at a higher risk for overuse injury," says Dr. DiNucci.
No matter the sport, athletes must take preventive methods to protect their feet to keep themselves in the game. Supportive shoes tailored to the sport are vital, along with proper training and stretching before and after play. If athletes are injured or experience pain or discomfort in their feet or ankles, it's best to be examined by a foot and ankle surgeon. Early intervention is the key to proper healing.
As for Donna, she's back on her feet and has made modifications to her game, such as stretching before and after a match and wearing more supportive shoes with her orthotics.
Source: American College of Foot and Ankle Surgeons
четверг, 18 августа 2011 г.
First Gene Linked To Scoliosis Identified By Scientists
Physicians have recognized scoliosis, the abnormal curvature of the spine, since the time of Hippocrates, but its causes have remained a mystery -- until now. For the first time, researchers have discovered a gene that underlies the condition, which affects about 3 percent of all children.
The new finding lays the groundwork for determining how a defect in the gene -- known as CHD7 -- leads to the C- and S-shaped curves that characterize scoliosis. The gene's link to scoliosis was identified by scientists at Washington University School of Medicine in St. Louis, working in collaboration with investigators at the University of Texas Southwestern Medical Center and Texas Scottish Rite Hospital for Children, both in Dallas, Rutgers State University of New Jersey and the University of Iowa. The group published its results in May in the American Journal of Human Genetics.
"Hopefully, we can now begin to understand the steps by which the gene affects spinal development," says Anne Bowcock, Ph.D., professor of genetics, of medicine and of pediatrics. "If we understand the genetic basis of the condition, we can theoretically predict who is going to develop scoliosis and develop treatments to intervene before the deformity sets in. It may take many years to accomplish these goals, but I think it will eventually happen."
The researchers have traced a defect in CHD7 to idiopathic scoliosis, the form of the condition for which there is no apparent cause. It is the most common type of scoliosis, occurs in otherwise healthy children and is typically detected during the growth spurt that accompanies adolescence.
Although scientists have known for years that scoliosis runs in families, its pattern of inheritance has remained unclear. That's because the condition is likely caused by several different genes that work in concert with one another -- and the environment -- to cause scoliosis. Bowcock predicts that scientists will soon find other genes involved in the disease.
The CHD7 gene is thought to play a critical role in many basic functions in the cell. The researchers zeroed in on the gene after finding that it is missing or profoundly disrupted in a rare syndrome called CHARGE. Babies born with the syndrome often die in infancy. Those that survive have heart defects, mental retardation, genital and urinary problems, ear abnormalities and deafness, among other problems. They also develop late-onset scoliosis.
"This led us to consider that milder variations of CHD7 may be involved in other types of scoliosis," Bowcock said.
The researchers, led by Carol Wise, Ph.D., at Scottish Rite Hospital, collected data on 52 families with a history of scoliosis in at least two members -- the one who sought treatment and another from earlier generation. The patients had an average spinal curvature of 40 degrees and did not have any illnesses, such as Marfan syndrome or cerebral palsy, which can also involve scoliosis. The researchers performed genome-wide scans that spelled out the 6 billion letters of genetic code in the affected family members and analyzed the data.
They found that patients with scoliosis very often had a defect in the gene's non-coding region, meaning that the error did not disrupt production of the CHD7 protein. The researchers speculate that this particular mutation alters the binding of a molecule that controls whether the gene is turned on. In this case, they think the gene is turned off more often than it should be, which reduces the amount of CHD7 protein produced.
"The change in the amount of the protein produced is subtle, which correlates with the onset of scoliosis, which typically happens very gradually," explains Michael Lovett, Ph.D., professor of genetics and pediatrics. "This particular defect was so highly associated with scoliosis that it is either the real McCoy or is very closely linked to the defect that causes the condition."
The researchers will continue to look for genetic variations involved in scoliosis by studying additional families with the condition.
Severe scoliosis is typically treated by surgery or by wearing an orthopedic brace, which straightens the curvature over time. Most minor spinal curves can be monitored by a doctor and do not progress to the point where treatment is necessary.
Gao X, Gordon D, Zhang D, Browne R, Helms C, Gillum J, Weber S, Devroy S, Swaney S, Dobbs M, Morcuende J, Sheffield V, Lovett M, Bowcock A, Herrine J and Wise C. CHD7 Gene polymorphisms are associated with susceptibility to idiopathic scoliosis. American Journal of Human Genetics, vol. 80, p. 957-965. May 2007.
Washington University School of Medicine's full-time and volunteer faculty physicians also are the medical staff of Barnes-Jewish and St. Louis Children's hospitals. The School of Medicine is one of the leading medical research, teaching and patient care institutions in the nation, currently ranked fourth in the nation by U.S. News & World Report. Through its affiliations with Barnes-Jewish and St. Louis Children's hospitals, the School of Medicine is linked to BJC HealthCare.
Contact: Caroline Arbanas
Washington University School of Medicine
The new finding lays the groundwork for determining how a defect in the gene -- known as CHD7 -- leads to the C- and S-shaped curves that characterize scoliosis. The gene's link to scoliosis was identified by scientists at Washington University School of Medicine in St. Louis, working in collaboration with investigators at the University of Texas Southwestern Medical Center and Texas Scottish Rite Hospital for Children, both in Dallas, Rutgers State University of New Jersey and the University of Iowa. The group published its results in May in the American Journal of Human Genetics.
"Hopefully, we can now begin to understand the steps by which the gene affects spinal development," says Anne Bowcock, Ph.D., professor of genetics, of medicine and of pediatrics. "If we understand the genetic basis of the condition, we can theoretically predict who is going to develop scoliosis and develop treatments to intervene before the deformity sets in. It may take many years to accomplish these goals, but I think it will eventually happen."
The researchers have traced a defect in CHD7 to idiopathic scoliosis, the form of the condition for which there is no apparent cause. It is the most common type of scoliosis, occurs in otherwise healthy children and is typically detected during the growth spurt that accompanies adolescence.
Although scientists have known for years that scoliosis runs in families, its pattern of inheritance has remained unclear. That's because the condition is likely caused by several different genes that work in concert with one another -- and the environment -- to cause scoliosis. Bowcock predicts that scientists will soon find other genes involved in the disease.
The CHD7 gene is thought to play a critical role in many basic functions in the cell. The researchers zeroed in on the gene after finding that it is missing or profoundly disrupted in a rare syndrome called CHARGE. Babies born with the syndrome often die in infancy. Those that survive have heart defects, mental retardation, genital and urinary problems, ear abnormalities and deafness, among other problems. They also develop late-onset scoliosis.
"This led us to consider that milder variations of CHD7 may be involved in other types of scoliosis," Bowcock said.
The researchers, led by Carol Wise, Ph.D., at Scottish Rite Hospital, collected data on 52 families with a history of scoliosis in at least two members -- the one who sought treatment and another from earlier generation. The patients had an average spinal curvature of 40 degrees and did not have any illnesses, such as Marfan syndrome or cerebral palsy, which can also involve scoliosis. The researchers performed genome-wide scans that spelled out the 6 billion letters of genetic code in the affected family members and analyzed the data.
They found that patients with scoliosis very often had a defect in the gene's non-coding region, meaning that the error did not disrupt production of the CHD7 protein. The researchers speculate that this particular mutation alters the binding of a molecule that controls whether the gene is turned on. In this case, they think the gene is turned off more often than it should be, which reduces the amount of CHD7 protein produced.
"The change in the amount of the protein produced is subtle, which correlates with the onset of scoliosis, which typically happens very gradually," explains Michael Lovett, Ph.D., professor of genetics and pediatrics. "This particular defect was so highly associated with scoliosis that it is either the real McCoy or is very closely linked to the defect that causes the condition."
The researchers will continue to look for genetic variations involved in scoliosis by studying additional families with the condition.
Severe scoliosis is typically treated by surgery or by wearing an orthopedic brace, which straightens the curvature over time. Most minor spinal curves can be monitored by a doctor and do not progress to the point where treatment is necessary.
Gao X, Gordon D, Zhang D, Browne R, Helms C, Gillum J, Weber S, Devroy S, Swaney S, Dobbs M, Morcuende J, Sheffield V, Lovett M, Bowcock A, Herrine J and Wise C. CHD7 Gene polymorphisms are associated with susceptibility to idiopathic scoliosis. American Journal of Human Genetics, vol. 80, p. 957-965. May 2007.
Washington University School of Medicine's full-time and volunteer faculty physicians also are the medical staff of Barnes-Jewish and St. Louis Children's hospitals. The School of Medicine is one of the leading medical research, teaching and patient care institutions in the nation, currently ranked fourth in the nation by U.S. News & World Report. Through its affiliations with Barnes-Jewish and St. Louis Children's hospitals, the School of Medicine is linked to BJC HealthCare.
Contact: Caroline Arbanas
Washington University School of Medicine
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